Unhealthy Quest for Lighter Skin Fuels Bleaching Epidemic

A centuries-old cosmetic practice has evolved into a worldwide epidemic of potentially harmful skin bleaching, according to a specialist in skin of color dermatology and pigmentation disorders.

The epidemic has its origin in cultural beliefs, stereotypes, and myths that help perpetuate the belief that lighter skin is a desirable trait, more desirable than darker skin. The belief system has fueled a worldwide market for skin lightening or bleaching products, many of them unapproved or unregulated and potentially dangerous. The global market for the products was estimated at $8.6 billion in 2020 and is expected to exceed $12 billion by 2027.

Advertising and marketing reinforce the cultural beliefs and stereotypes with product names such as “Fair and Lovely” and “Fair and Handsome,” said Seemal R. Desai, MD, a Dallas-based specialist in skin of color and pigmentary disorders.

“The cultural beliefs that promote the practice of skin bleaching date back centuries and deeply affect many of our patients with skin of color,” said Desai, of the UT Southwestern Medical Center and medical director of a private dermatology practice for patients with skin of color. “It’s going to take time to change these deeply rooted cultural values and psychological associations with lighter skin tones. However, we want to educate patients about the dangers of skin bleaching [that is] strictly for the sake of achieving lighter skin.”

During the American Academy of Dermatology virtual meeting, Desai addressed the cultural, psychological, and safety aspects of skin bleaching. Perpetrated and perpetuated by myths and sociocultural pressures, the belief that lighter skin makes a person more desirable can cause lasting psychological effects, and the quest to achieve it can be potentially dangerous.

When used appropriately, as advised by a dermatologist, bleaching products can be used safely to treat pigmentary disorders such as melasma, he pointed out. However, many patients purchase bleaching agents online from foreign sources for the sole purpose of having lighter skin.

Some products contain high levels of chemicals that are toxic to the skin. For example, hydroquinone and topical steroids, when used in combination, can inhibit production of melanin, the naturally occurring pigmentation substance that gives skin its color. Other potential adverse effects of unapproved and unregulated bleaching agents include rashes, steroid-induced acne, scarring, skin thinning, and skin ulceration, said Desai.

Several recent studies have reinforced the potential hazards of do-it-yourself skin lightening products. A review of global regulation of heavy metals in bleaching agents and related products showed that many low-income nations have no standards for permissible concentrations. A laboratory analysis of skin-whitening products showed wide variation in concentrations of “noxious” heavy metals. Yet another study showed that few skin-lightening creams marketed as “mercury free” were actually free of the toxic heavy metal, and some of the products contained arsenic.

On the regulatory front, health-related agencies in several countries have taken action to curb the sale and marketing of unapproved and potentially unsafe skin-bleaching products. A federal judge sided with the FDA to order a New Jersey-based company to stop distributing injectable skin-whitening agents and other unapproved products. Just last year the FDA Philippines issued a public health warning about an entire line of skin-bleaching products marketed under the “Blessed Essential” brand.

The internet and social media have been “huge drivers” of myths and stereotypes about skin color and bleaching products, said Desai. A few years ago, influential pushback came from a movement known as #unfairandlovely, which sought to counter “colorism and the belief that skin color dictates one’s own perception of beauty.” The movement gained considerable exposure and traction from a BBC feature about the campaign.

Backlash generated by #unfairandlovely and Black Lives Matter contributed directly to Unilever’s decision in 2020 to rebrand its “Fair and Lovely” product line. In a statement, company officials acknowledged that the brand suggested a “singular ideal of beauty that we don’t think is right.” However, the company insisted “the brand has never been and is not a bleaching product.”

Desai encouraged dermatologists to take the lead in countering the harmful psychological and potential physical effects that can occur as a result of myths and stereotypes about skin color.

“If skin lightening and bleaching is being done solely for cosmetic reasons, it’s an unsafe practice,” he told MedPage Today. “Dermatologists who do not dissuade their patients, by explaining the reasons why this is not something we advocate, are doing a disservice.”

“We need to empower our patients when they’re really trying to sort these things out,” he added. “We also need to not feed into this. As dermatologists it’s our job to help break the cycle of societal myth. That may take decades, but we’ve got to do it and it starts with us.”