Socially Sensitive Discussions Are Needed About Skin Lighteners

Skin bleaching agents bring in billions of dollars a year, with a World Health Organization (WHO) survey reporting that up to 50% of women in the Philippines report their use, but it’s important to inform patients because these products are largely unregulated and could actually damage the skin.

Theodore Rosen, MD, professor of dermatology at Baylor College of Medicine in Houston, Texas, discussed skin bleaching agents at the Florida Society of Dermatology Physician Assistants’ New Wave Dermatology Conference being held this week in Coral Gables, Florida.

Rosen noted that because skin whiteners are often sold over-the-counter at beauty salons, patients may not discuss their use with their doctors because they don’t consider them potentially harmful. It is for this reason that Rosen encourages a socially sensitive discussion with his patients about their use.

“Socially sensitive interventions are needed,” he said. “You can say, ‘I would like to understand why you are doing this, and while you are telling me, I must warn you that these things may be dangerous, that they may not do what you want them to do, and in fact, they can do the exact opposite and damage your liver or kidneys.

Rosen noted that cultural views on skin lightening are rooted in history. Skin lightening is an ancient tradition that persists today.

“In ancient times, looking fair meant you didn’t have to work outdoors, so skin-lightening efforts became quite common,” he said, noting that ancient Egyptians used chalk dust to lighten the skin, and in ancient Japan, rice powder was used.

Colonial rule by lighter-skinned nations, such as England, France, Germany, and Spain, also perpetuated the belief that power can be tied to lighter skin. Adding to this historical pressure, Rosen pointed to a plethora of marketing campaigns, particularly in Asia where whitener use is very common, that associate clearer skin with beauty.

Today, “colorism” or “shadeism” remains common, with several studies suggesting differences in how people were educated, earned money, or even judged in court based solely on the color of their skin. A study published in Psychological sciences concluded, “the more a defendant is perceived as stereotypically black, the more likely he or she is to be sentenced to death.”

All of this historical and marketing pressure has led to an industry worth billions of various topical, oral, and IV agents that are in use and vary in effectiveness. Rosen noted that some of these products, like retinoids and vitamin C, are not particularly well suited for this use, and others like hydroquinone or mercury, or glutathione are more effective in their use but can have serious and significant adverse cutaneous and systemic effects.

“For many products offered for skin whitening: it is difficult to determine the country of origin or the full content, which makes risk assessment nearly impossible,” Rosen said, noting that when asked about these products with his patients, he generally replies “you are beautiful”. as you are” because offering recommendations on usage can be seen as an endorsement of their use, which he said, he does not.

References:

  1. Rosen T. What you need to know about skin lightening. Presented at: New Wave Dermatology Conference. April 28-May 1, 2022. Coral Gables, Florida.
  2. Eberhardt JL, Davies PG, Purdie-Vaughns VJ, et al. Looking Death-Worthy: Perceived Stereotyping of Black Defendants Predicts Capital Punishment Outcomes. Psychol Sci. 2006, 17:383-386

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