The unfair treatment of skin-lightening creams

Dr Vikas Sharma

Discrimination on the basis of skin colour as practiced in the modern glamourous world is, perhaps, the most visible form of racism. The issue, which came to light recently after protests around #BlackLivesMatter, became so discomforting that some brands, which have, so far, associated fairness with marriage, career and success in their advertisements, had to remove the word ‘fair’ from their brand name. However, will renaming a fairness cream stop this discrimination, especially when obsession for fair skin goes beyond age, caste, religion, and social status.

The craze with getting fairer can be judged from the fact that skin-lightening or “fairness” creams are big business in India. Skin-whitening products are particularly popular in Asian countries like India. This desire is exploited with advertisements of fairness creams, which allure youngsters, both men as well as women, with promises of miraculous results.

Products promising to lighten the face, body and armpits are available all across the country, with skin-whitening pills and diet supplements claiming to pick up where the cosmetics leave off. India’s skin lightening industry, which is growing at 18 per cent per year and is expected to reach $1bn this year, boasts of a plethora of skin whitening creams, lotions, whitening face cleansers, shower gels, and even genital washes that claim to lighten the surrounding skin.

There are many skin-whitening products available in the market, and one should not get carried away by the promising results claimed in commercials.

Hyperpigmentation

When it comes to conditions where a person with fairer complexion has turned dark, determining the cause of the skin darkening (hyper-pigmentation) is important in selecting the best approach for treatment. Getting a proper diagnosis of the pigmentation disorder by a dermatologist before undergoing a skin lightening treatment is of paramount importance. The causes of hyperpigmentation may include genetic, post-inflammatory hyperpigmentation, drugs, photosensitising agents, ultraviolet light, electromagnetic radiations or systemic disease (e.g. Addison disease, liver disease, pituitary tumors). In order to adequately treat the sudden or gradual skin darkening, the causative agent needs to be determined so a specific dermatological diagnosis is paramount.

Skin lightening

The specific skin-whitening treatment can help lighten a tan, fade scars, and alleviate dark patches on the skin and is done for specific hyper-pigmented disorders.

Topical skin lightening creams and lotions often contain chemical agents like hydroquinone, azelaic acid and kojic acid. Plant extracts that can help in skin lightening when applied topically include licorice extract and arbutin. Oral supplements that help in skin lightening include glutathione, grapeseed extract, vitamin C. There is also a small amount of research showing that oral supplements of pomegranate extract, pine bark extract and ellagic-acid can inhibit melanin production.

Unfortunately, many skin-lightening creams contain illegal compounds that can damage our health, the most common compounds being high-dose steroids. Hydroquinone is a strong inhibitor of melanin production. Its higher concentrations have been banned in some European countries because of fears of a cancer risk.

Hydroquinone can be a skin irritant, particularly in higher concentrations of 4 per cent or greater, and predictably when combined with tretinoin. Fairness creams give you a pleasant picture of making your skin white over a period of time, but this comes with consequences. Getting fairer faster can end up making your skin look bad in the long run. Among the toxic components, heavy metals like mercury, arsenic, lead, cobalt, cadmium, nickel and chromium are some of the major ingredients. Mercury salt is a commonly added ingredient as fairness agent.

The side effects

The common side-effects of skin-lightening cosmetics include both cutaneous and extra-cutaneous effects. All skin-lightening agents and procedures can be harmful unless done under the supervision of dermatologists. So exercise caution before starting such treatments. Non-prescription creams that claim to bleach or lighten your skin can be harmful as these can result in:

• Thinning of skin
• Uneven colour loss, leading to a blotchy appearance
• Redness
• Excessive facial hair growth
• Intense irritation
• Contact dermatitis

— The writer is chief consultant dermatologist, National Skin Hospital, Mansa Devi Complex