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When considering cosmetic enhancements, we generally think of common procedures such as Botox, facial fillers, chemical peels or liposuction. However, a less talked about procedure, anal bleaching, has gained popularity in recent years. Anal bleaching has garnered mainstream media attention with adult film stars and erotic entertainers visiting Dr. 90210 to lighten this particular area of the body which may be exposed during the course of their workday. Even gay icon Margaret Chounde rwent side-by-side anal bleaching with one of her best gays last year on her reality television show, The Cho Show.

 

An L.A. area salon seems to have pioneered this phenomenon a few years ago. With the popularity of total waxing of the genital region, clients were discovering areas of darker pigmentation, especially around the anus that were otherwise camouflaged by hair. Apparently, hundreds of clients have used their services with about one third being men.

 

Although many people routinely bleach their teeth or hair, when it comes to bleaching the delicate skin of the anal area it is important to understand the causes of skin darkening and the medical and safety concerns associated with the procedure. So, let’s explore the ins and outs of anal bleaching…

Causes of darkening: 

Skin darkening around the outer anus can be due to at least two main causes: increase in pigment or thickening of irritated skin. In orderto have effective treatment, i.e., lightening, the diagnosis must be determined. Increased pigment can be due to prior irritation or genetics.Thickening of skin, i.e., lichenification, may present as darkening, however it is truly increase in thickness of the top layer of the skin (epidermis). This irritation can be caused by many factors, including irritation from lack of hygiene,excessive rubbing of the area, chronic itch of the anus, pin worms, food allergy, over-aggressive anal sex, skin allergy to items coming in contact with the area.

 

There are a number of preparations for anal bleaching. After your physician has ruled out irritation causing anal skin darkening, I recommend the following treatments.

 

Here are the main treatments, from mild to deep:

 

Creams that lighten:

  1. Hydroquinone (HQ)

 

 2% HQ is readily available over the counter in various cosmetic preparations. Evidence of improvement with HQ alone is usually observed at 4-6 weeks, with improvement appearing to plateau at approximately 4 months. For better efficacy, HQ is also compounded into various mixtures for the treatment of hyperpigmentation. Tri-Luma is a popular, prescription skin-lightening agent that combines 4% HQ, a mild topical steroid and retinoid in a cream formulation.  Although it is not FDA approved for use in the anal skin area, under close physician supervision,it is safe and effective.

2. Azelaic acid

A naturally occurring acid, it has been formulated in topical preparations used to lighten skin. It is safer than hydroquinones and hydrocortisones.

3. Kojic acid

Kojic acid lightens skin and is safe in the anal area. It is usually mixed with a combination of the above two products. It can, however, cause irritation when used over a longperiod of time.

Procedures that causeanal bleaching:

  1. Application of up to 20% hydroquinone and glycolic acid: I do not recommend this because there is a concern with hydroquinone cancer-causing potential at does this high.

  2. Glycolic, salicylic or trichloroacetic acid (TCA) peel. These are very effective in lightening; however they are met with at least a week of irritation and redness, followed by a pink regrowth of skin. This should be only be performed by a licensed medical provider such as a physician or nurse practitioner.

  3. Light based skin lightening:

    1. Intense pulsed light (IPL) is an effective device to lighten skin. The procedure is widely-available and takes about 15 minutes and usually requires about 4 to 6 treatments. There is some discomfort involved as the procedure feels like getting snapped with a rubber band. The area may blister or scale for several days.

    2. For deeper pigment around the anus, a Q-switched ND-YAG laser, which is used for tattoo removal can address the deeper pigment. This  may be painful and needs topical and/or injected local anesthetic.

    3. Skin resurfacing lasers, like fractionated Er-YAG or CO2 lasers. These require local anesthesia and the recovery is up to 2 weeks.

My best advice in seeking anal bleaching is to find a medical provider with whom you are comfortable discussing this issue and approach it cautiously and safely with clinically-proven treatments and procedures.