Rx for Change: Skin Lightening
Melanin, a pigment found in most organisms, is the main determinant of human skin color (it is also found in hair and specific eye tissues). Melanin has two primary forms: red- or yellow-colored pheomelanin and brown- or black-colored eumelanin. People with dark skin have a larger percentage of eumelanin than those with fair skin.
Skin lighteners include compounds like hydroquinone, corticosteroids, and mercury,2 which can cause severe complications.
- Hydroquinone is a skin-lighting agent that is associated with numerous harmful side effects, the most common of which is a skin rash (irritant contact dermatitis). Other side effects include allergic contact dermatitis and patchy skin lightening (hypopigmentation). Prolonged exposure to hydroquinone may cause nail discoloration, damage to the cornea, impaired healing of wounds, and reopening of surgical incisions (wound dehiscence). The most severe side effect of continued hydroquinone use is a disorder characterized by blue-black pigmentation of the skin (exogenous ochronosis); to date, almost 800 cases have been reported.4
- Corticosteroids are a form of steroid hormones that can cause skin lightening. Side effects include allergic contact dermatitis, a skin rash near the mouth (perioral dermatitis), thinning of the skin (skin atrophy), excessive hair growth (hypertrichosis), redness and visible blood vessels (rosacea), and stretch marks (striae atrophicae). If used for several months or years, corticosteroids can cause multi-system consequences including: cataracts, glaucoma, increased infection risk, fragile bones (osteoporosis), high blood sugar (hyperglycemia), diabetes, and hypertension.2
- Mercury is a chemical element that blocks melanin production, is extremely toxic, and can trigger both acute and chronic side effects.4 Acute side effects include inflammation of lung tissue (pneumonitis) and gastric distress. Chronic use of mercury-containing skin lighteners can cause neurological complications including tremors, memory loss, anxiety, depression, and psychosis; toxicity of the kidneys (nephrotoxicity); and — ironically —hyper-pigmentation.
Given the numerous dangers associated with skin-lightening products, many countries have restricted their importation and sale,2 including Australia, Côte d'Ivoire, Ghana, Japan, Rwanda and South Africa.
Since 1973, the U.S. Food and Drug Administration (FDA) has banned the use of mercury in cosmetics at levels exceeding one part per million (1 ppm). In 2019, the agency discovered a skin cream (Manning Beauty Cream) composed of approximately eight percent mercury by weight, and issued an import alert for mercury-containing bleaching creams. While this alert enables FDA agents to seize these products, the agency’s ability to monitor and manage cosmetic imports is limited. In 2006, the FDA proposed a ban on all over-the-counter skin lighteners containing hydroquinone (excluding products that were approved through the agency’s New Drug Application review system).2 The ban—which has not been implemented—was developed in response to a growing number of exogenous ochronosis cases.
Despite the clear, documented side effects of skin lightening products, and the growing number of national bans, these cosmetics continue to be frequently used, particularly in African and Asian nations. According to the World Health Organization (WHO), 77% of women in Nigeria report frequent use of these bleaching products, as do 59% of women in Togo, 35% of women in South Africa, and 27% of women in Senegal. A 2004 study found that 40% of female respondents in China, Malaysia, the Philippines, and the Republic of Korea reported using skin lighteners.7 Skin lighteners comprise 61% of India’s skin care market.7
Why are such damaging products still being used, by so many women?
While individual incentives differ, many women bleach because of the prospect of gaining higher status — and, with the privileges afforded to those with lighter skin, who can blame them? Among Black women in the U.S., lighter skin predicts higher educational achievement and earnings. Complexion affects employment opportunities, too; when evaluated by white interviewers, light-skinned Black and Hispanic job applicants were perceived as being more intelligent compared to darker-skinned applicants with the same qualifications.
The practice of bleaching may also be driven by the desire to attract a partner (possibly because many societies perpetuate the idea that a woman’s worth is demonstrated by her ability to find a man). In one study of 600 Nigerian adolescent students, the top three reasons for skin bleaching were to “gain the attention of male folk,” “get desired marriage partners,” and “successfully maintain premarital relationships.”
Skin lightening is hardly a new practice: the first documented treatment dates back to 4,000 BC, in ancient Egypt. At the height of slave trading in North Africa, slave owners used bleaching to lighten enslaved peopes’ skin after extended sun exposure. The practice has persisted and even flourished, due to a global culture of “colorism,” discrimination against people with dark complexions. For centuries, Black and Brown women have had to conform to Eurocentric beauty standards. Today, these damaging ideals are perpetuated throughout mass media; more music videos and cosmetic advertisements feature white women than women of color.11 Meanwhile, celebrities like Blac Chyna and Azealia Banks tout skin lighteners, pressuring women to question the skin they’re in.
It’s time that we condemn not only the producers and vendors of these unsafe products but also the misogynistic, racist culture that allows them to prosper. It’s time we addressed bleaching cosmetics for what they are: an attack on dark-skinned women.
Nitika Gupta is currently pursuing an M.S. in Health and the Public Interest at Georgetown University.
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 Santos-Longhurst A, “Side effects and precautions of skin bleaching,” Healthline Media, 2019 https://www.healthline.com/health/skin-bleaching.
 Olumide YM, Akinkugbe AO, Altraide D, et al., “Complications of chronic use of skin lightening cosmetics,”Int J Dermatol, 2008; 47(4):344-353. doi:10.1111/j.1365-4632.2008.02719.x
 Solano F, “Melanins: Skin Pigments and Much More—Types, Structural Models, Biological Functions, and Formation Routes,” New J Sci., 2014; 2014:1-28. doi:10.1155/2014/498276.
 Ladizinski B, Mistry N, Kundu RV, “Widespread use of toxic skin lightening compounds: Medical and psychosocial aspects.” Dermatol Clin., 2011; 29(1):111-123. doi:10.1016/j.det.2010.08.010
 Garcia S, “Rwanda cracks down on skin bleaching agents by seizing cosmetics,” The New York Times, January 9, 2019. Online: https://www.nytimes.com/2019/01/09/world/africa/skin-bleaching-banned-rwanda.html.
 U.S. Food and Drug Administration (FDA), Import Alert 53-18, Silver Spring (MD): FDA, 2019. https://www.accessdata.fda.gov/cms_ia/importalert_137.html.
 World Health Organization, (WHO), Preventing Disease through Healthy Environments: Mercury in Skin Lightening Products. Geneva: WHO, 2011. Online: http://www.who.int/ipcs/assessment/public_health/mercury/en/index.html.
 Hunter ML, “’If you’re light you’re alright:’ Light skin color as social capital for women of color,” Gend Soc. 2002; 16(2): 175-193. doi:10.1177/08912430222104895.
 Hannon L, “ White colorism,” Soc Curr., 2015; 2(1):13-21. doi:10.1177/2329496514558628
 Durosaro I, Ajiboye SK, Oniye AO, “Perception of skin bleaching among female secondary school students in Ibadan Metropolis, Nigeria,” J Educ Pract. 2012; 3(7). Online: https://www.iiste.org/Journals/index.php/JEP/article/view/1847.
 Apuke OD, Why do women bleach? Understanding the rationale behind skin bleaching and the influence of media in promoting skin bleaching: A narrative review,” Glob Media J., 2018; 16(30): 1-4. Online: http://www.globalmediajournal.com/open-access/why-do-women-bleach-understanding-the-rationale-behind-skin-bleachingand-the-influence-of-media-in-promoting-skin-bleaching-a-narr.php?aid=86820#16.