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Skin-Lightening Agents – What Users Don’t Know Could Hurt Them

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Researchers from Northwestern University have conducted a study to explore skin lightening habits among skin of color (SOC) individuals in the United States. The study, published in the International Journal of Women’s Dermatology, suggests a lack of awareness exists about the potential dangers associated with this practice.

Increased adoption of skin-lightening agents globally

An increasing number of SOC individuals are choosing to lighten the color of their skin via chemical means, a practice known as skin lightening and bleaching. The rising rates of this practice are heavily attributed to the pressures of social media and popular culture, where colorism – a system of inequality that awards opportunities and privilege to lighter-skinned populations – is prevalent. Many celebrities have openly discussed the intense pressures faced by SOC individuals in the entertainment industry to lighten their skin.

“Skin lightening poses a potential threat to consumers and raises challenges for dermatologists due to products containing ingredients that may lead to adverse health consequences, particularly with prolonged use and lack of medical consultation,” the authors of the new study, led by Dr. Roopal Kundu, founder and director of the Northwestern Medicine Center for Ethnic Skin and Hair, write.

Global rates of skin lightening vary, estimated to stand at 27% in South Africa, 40% in China and South Korea and as high as 77% in Nigeria. Exactly how common this practice is in the U.S., and how people’s attitudes fare towards it, is unknown – this was the focus of Kundu and colleagues’ latest work.

The new study adopted a self-report methodology where 455 participants received and completed a cross-sectional survey. The survey posed 19 questions on participants’ demographics, rates of skin lightening, habits and perceived colorism among skin lightening users and non-users.

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The participants were largely women, with smaller groups of men, nonbinary and other individuals recruited for the study. Among these individuals, skin lightening agent users were 44 years of age on average, and identified as Black or African American (52.3%), Asian (18.2%), multiracial (18.5%), Hispanic (6.8%) and American Indian or Alaska Native (3.1%).

Participants using skin lightening agents did not consult a physician

Over 21% of the survey participants reported using skin lightening agents, of which 73.2% reported using them for the treatment of a skin condition and almost 27% for general use. Skin lighteners may be prescribed to treat specific conditions such as melasma, where the product is used safely under the guidance of a physician. But Kundu and colleagues found only 22% of the individuals adopting skin lightening practices had consulted with a physician or medical provider beforehand, and almost 50% were unaware of the ingredients their product contained.

“The most surprising finding was the lack of awareness of ingredients in products being purchased over the counter and their potential detrimental effects,” says Kundu. “These products are bought from chain grocery stores, community-based stores or even online and do not undergo the same type of regulation as large-chain store or prescription products.”

Hydroquinone-based products were used by some participants, which concerned the researchers as the United States Food and Drug Administration (FDA) has previously reported adverse effects from this ingredient, including facial swelling, skin discoloration and rashes.

Participants using skin-lightening agents reported a stronger perception of colorism in their lives than individuals that did not lighten their skin. “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 describes. “The belief is that having lighter skin is tied to personal and professional success.”

She concludes, “As dermatologists, we hope to understand the cultural and societal influences that impact skin health and treatment of skin disease. 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: Daftary K, Poondru S, Patel N, Shramuk M, Muhammad L, Kundu RV. Colorism attitudes and use of skin lightening agents in the United States. Int J Women's Dermatol. 2023;9(3). doi: 10.1097/JW9.0000000000000092

This article is a rework of a press release issued by Northwestern University. Material has been edited for length and content.