Skin bleaching reduces the concentration of melanin in the skin, leading to a lighter appearance. The process involves the application of topical agents containing substances such as hydroquinone, mercury, or corticosteroids to lighten the skin’s melanin concentration. This practice, prevalent in various populations, has been associated with potential adverse effects including skin irritation, mercury poisoning, and an increased risk of skin cancer.
Skin bleaching is common among individuals of color in the U.S.
Skin-lightening practices are widespread in the U.S., especially among individuals of color – particularly women. However, many users of these products may not be fully aware of the associated risks according to a recent Northwestern Medicine study.
The study further reveals that these practices are often fueled by colorism, a societal bias that favors lighter skin tones as being more desirable and beneficial. The findings also reinforced the prevalence of skin lightening in the U.S.
“The most surprising finding was the lack of awareness of ingredients in products being purchased over the counter and their potential detrimental effects,” said lead investigator Dr. Roopal Kundu, founder and director of the Northwestern Medicine Center for Ethnic Skin and Hair. “These products are bought from chain grocery stores, community-based stores, or even online and do not undergo the same type of regulation as a large-chain store or prescription products.”
Kundu is also a professor of dermatology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine board-certified dermatologist.
The study will be published July 13 in the International Journal of Women’s Dermatology.
Previous studies show these products are often adulterated with other things such as steroids and mercury that could be toxic to the skin.
One of Kundu’s patients used the lightening product hydroquinone, also called a bleacher, on his entire face for many years. The patient now has permanent hyperpigmentation.
Doctors prescribe skin lighteners for some skin conditions such as melasma, and the products can be safely used under physician guidance. But most people who use skin lighteners also do not consult a medical provider before use, Kundu said.
In 2020, the FDA received reports of serious side effects from the use of skin-lightening products containing hydroquinone, including skin rashes, facial swelling, and exogenous ochronosis (discoloration of the skin.) The FDA advised consumers not to use these products due to the potential harm they may cause.
Colorism is behind skin lightening
The participants – 80% women – who used skin lighteners perceived stronger colorism in their lives than those who did not use the products, according to the study.
“There is this perception that having lighter skin within a group – Southeast Asian or African populations, for example – is looked upon more favorably and manifests by making someone more attractive to a mate or more likely to get a job,” Kundu said. “The belief is that having lighter skin is tied to personal and professional success.”
Most of Kundu’s patients interested in skin lightening want to do so to even out skin tone due to a skin disease. However, a fourth of the study participants wanted to do general skin lightening. One of Kundu’s patients recently told her his goal was to completely lighten his skin. “I had to tell him that is not something we can do,” Kundu said. “We weren’t going to globally lighten his skin color.”
To conduct the study, researchers sent an anonymous 19-question survey to individuals with skin of color in the U.S. asking about their demographics, colorism attitudes, skin tone satisfaction, and skin-lightening habits. Of 455 individuals who completed the survey, 238 were Black, 83 were Asian, 84 were multiracial, 31 were Hispanic, 14 were American Indian or Alaskan Native, and five identified as other.
The use of skin-lightening agents was reported by 21.3% of respondents, with 75.3% of these respondents using them to treat skin conditions such as acne, melasma, or hyperpigmentation. The others were using the agents for general skin lightening.
“As dermatologists, we hope to understand the cultural and societal influences that impact skin health and treatment of skin disease,” Kundu said. “Cultural mindfulness for clinicians as they get to know their patients battling pigmentary issues allows for the safe, effective, comprehensive and compassionate treatment of dermatological disease across all communities.”
Reference: “Colorism attitudes and use of skin lightening agents in the United States” by Karishma Daftary, Sneha Poondru, Nina Patel, Maxwell Shramuk, Lutfiyya Muhammad and Roopal V. Kundu, October 2023, International Journal of Women’s Dermatology.
DOI: 10.1097/JW9.0000000000000092
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