Skin whitening reduces the concentration of melanin in the skin, making the skin look whiter. This procedure involves using topical agents containing substances such as hydroquinone, mercury, or corticosteroids to lighten the concentration of melanin in the skin. The practice is prevalent among different populations but is associated with potential adverse effects, including skin irritation, mercury poisoning and an increased risk of skin cancer.
The practice of skin bleaching is common in the United States, especially among people of color, especially 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 revealed that these practices are often fueled by colorism, a social bias that views people with lighter skin as more desirable and beneficial. The findings also further support the prevalence of skin lightening in the United States.
"The most surprising finding was the lack of awareness about the ingredients in over-the-counter products and their potential harmful effects," said lead researcher Dr. Roopal Kundu, founder and director of Northwestern Medicine's Ethnic Skin and Hair Center. "These products are purchased from chain grocery stores, community stores and even online and are not regulated like large chain stores or prescription products."
Kundu is also a professor of dermatology at Northwestern University Feinberg School of Medicine and a Northwestern Medical Board-certified dermatologist.
The study will be published July 13 in the International Journal of Women's Dermatology.
Previous research has shown that these products are often adulterated with skin-toxic substances such as steroids and mercury.
One of Kundu's patients had been using the whitening product hydroquinone, also known as bleach, all over his face for years. The patient now suffers from permanent pigmentation.
Doctors prescribe whitening agents for certain skin conditions, such as melasma, and these products can be used safely under a doctor's supervision. But Kundu said most people who use whitening agents don't consult a doctor before using them either.
In 2020, the U.S. Food and Drug Administration (FDA) received reports of serious side effects from the use of whitening products containing hydroquinone, including rash, facial swelling, and extrinsic hyperpigmentation (skin discoloration).
The study showed that participants who used skin lightening products (80% were women) experienced greater colorism in their lives than those who did not use these products.
"There is a belief that within a group, such as Southeast Asians or Africans, people with lighter skin are favored as being more attractive to a mate or more likely to find a job," Kundu said. "There is a belief that light skin is associated with personal and professional success."
Most patients are interested in skin whitening, which they hope to even out skin tone caused by skin diseases. However, a quarter of study participants wanted general skin whitening. One of Kundu's patients recently told her that his goal was to completely whiten his skin. "I had to tell him that this is not something we can do, we are not going to dilute his skin color globally."
To conduct the study, researchers sent an anonymous 19-question survey to people of color in the United States asking about their demographics, colorist attitudes, skin tone satisfaction and skin lightening habits. Of the 455 people who completed the survey, 238 were Black, 83 were Asian, 84 were multiracial, 31 were Hispanic, 14 were American Indian or Alaska Native, and 5 were of other races.
21.3% of respondents reported using whitening agents, of which 75.3% used whitening agents to treat skin diseases such as acne, chloasma or pigmentation. Other respondents used these agents for general skin whitening.
"As dermatologists, we want to understand the cultural and social factors that influence skin health and skin disease treatment," said Kundu. "Clinicians need to pay attention to cultural factors when understanding patients who struggle with pigment problems so that they can treat skin diseases in all communities safely, effectively, comprehensively, and compassionately."