·  Colorism – system of inequality that views lighter skin as more beautiful and advantageous – motivates skin lightening

·  Users aren’t aware of adulterated ingredients in over-the-counter products such as mercury and steroids 
·  Products are purchased from chain grocery stores or online, used without medical advice

Newswise — CHICAGO --Skin bleaching is widespread in the U.S. among individuals with darker complexions – especially women – yet users of these products are unaware of the dangers, according to a recent study by Northwestern Medicine.

The study further discovered that colorism, the discriminatory system that values lighter skin as more attractive and advantageous, can serve as a driving force behind the practice of skin bleaching. These findings also underscored the pervasiveness of skin lightening in the United States.

"The most striking discovery was the respondents' limited knowledge regarding the ingredients present in over-the-counter products and their potential harmful consequences," noted Dr. Roopal Kundu, the lead researcher and the founder/director of the Northwestern Medicine Center for Ethnic Skin and Hair. "These products are commonly acquired from local grocery stores, community-based shops, or even online platforms, and they do not undergo the same rigorous regulations as major retail chains or prescription-based items."

Additionally, Dr. Roopal Kundu holds the positions of a dermatology professor at Northwestern University Feinberg School of Medicine and a board-certified dermatologist within the Northwestern Medicine network.

The study will be published July 13 in the International Journal of Women’s Dermatology.

Prior research has indicated that these products are frequently contaminated with substances like steroids and mercury, which can be detrimental to the skin and overall health.

One of Dr. Kundu's patients had been using hydroquinone, a lightening product commonly referred to as a bleacher, on his entire face for an extended period. As a result, the patient now suffers from permanent hyperpigmentation, a condition characterized by darkened areas of the skin.

While physicians may prescribe skin lighteners for specific skin conditions like melasma, these products can be used safely under the guidance of a medical professional. However, Dr. Kundu noted that the majority of individuals who use skin lighteners do so without consulting a healthcare provider beforehand.

During 2020, the Food and Drug Administration (FDA) received numerous reports detailing severe side effects associated with the use of skin lightening products that contained hydroquinone. These adverse effects included skin rashes, facial swelling, and the development of exogenous ochronosis, a condition characterized by skin discoloration. In response, the FDA issued an advisory urging consumers to refrain from using these products due to their potential for harm.

Colorism is behind skin lightening

According to the study, the participants, of whom 80% were women, who used skin lighteners reported experiencing more pronounced colorism in their daily lives compared to those who did not use such products.

Dr. Kundu remarked, "There exists a perception that having lighter skin is regarded more positively within certain communities, such as Southeast Asian or African populations. This belief suggests that lighter skin is associated with increased attractiveness to potential partners or higher chances of securing employment. The notion is that lighter skin is intertwined with personal and professional achievements."

Dr. Kundu's observations indicate that a majority of her patients seeking skin lightening procedures are motivated by a desire to address uneven skin tone caused by a skin disease. However, approximately one-fourth of the study participants expressed a desire for overall skin lightening. Dr. Kundu shared an incident where one of her patients expressed his goal of completely lightening his skin. In response, she clarified that such a comprehensive alteration of skin color was not feasible or within the scope of their treatments.

For the study, researchers distributed a confidential survey consisting of 19 questions to individuals with skin of color residing in the United States. The survey encompassed inquiries related to participants' demographics, attitudes towards colorism, satisfaction with their skin tone, and their habits regarding skin lightening. Out of the total 455 respondents who completed the survey, the breakdown by racial or ethnic background was as follows: 238 identified as Black, 83 as Asian, 84 as multiracial, 31 as Hispanic, 14 as American Indian or Alaskan Native, and five identified as other.

21.3% of participants reported utilizing skin brightening substances, and of these individuals, 75.3% employed them to address skin-related issues like acne, melasma, or hyperpigmentation. The remaining respondents employed the substances for overall skin brightening purposes.

"As dermatologists, our aim is to comprehend the cultural and societal factors that influence skin health and the management of skin conditions," Kundu expressed. "By being culturally aware, clinicians can better understand patients dealing with pigmentary concerns, enabling them to provide safe, effective, comprehensive, and empathetic dermatological treatments to individuals from all communities."

Co-authors include Dr. Karishma Daftary, Sneha Poondru, Nina Patel, Maxwell Shramuk, and Lutifyya Muhammad. 

The title of the article is “Colorism Attitudes and Use of Skin Lightening Agents in the United States.”

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International Journal of Women’s Dermatology