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Skin Whitening

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Skin whitening, also known as skin lightening, and skin bleaching, is the practice of using chemical substances in an attempt to lighten the skin or provide an even skin color by reducing the melanin concentration in the skin. Several chemicals are effective in skin whitening, while some have proven to be toxic or have questionable safety profiles. This includes mercury compounds which may cause neurological and kidney problems.

In several African countries, between 25 and 80% of women regularly use skin whitening products. In Asia, this number is around 40%. In India, specifically, over half of the skincare products are sold to whiten skin.

Efforts to lighten the skin date back to at least the 1500s in Asia. While several agents - such as kojic acid and alpha hydroxy acid - are allowed in cosmetics in Europe, several others such as hydroquinone and tretinoin are not. While some countries do not allow mercury compounds in cosmetics, others still do, and they can be purchased online.

Use
Areas of increased pigmentation such as moles may be depigmented to match the surrounding skin. Effective agents for specific areas include corticosteroids, tretinoin, and hydroquinone. These agents, however, are not allowed in cosmetics in Europe due to concerns of side effects. Attempts to whiten large areas of skin may also be carried out by certain cultures. This may be done for reasons of appearance, politics, or economics. Skin whiteners can help you achieve lighter skin tones, many of them contain harmful ingredients like the steroid clobetasol propionate, inorganic mercury (mercuric chloride or amalgamated mercury), glutathione (an antioxidant traditionally used in cancer treatment), and the organic compound hydroquinone. Skin lighteners main health risks are linked to;

  1. The overuse of topical clobetasol, which can cause systematic steroid effects from daily usage, especially on broad skin regions.
  2. Concealed mercury content, which can lead to mercury poisoning depending on individual susceptibility. Many skin whiteners contain a toxic form of mercury as the active ingredient. Their use, therefore, may harm a person's health and is illegal in many countries.

Hydroquinone is a commonly used agent in skin whiteners, though the European Union banned it from cosmetics in 2000. It works by decreasing melanin production. Tretinoin, also known as all-trans retinoic acid, may be used to whiten specific areas. It may be used in combination with steroids and hydroquinone. 

Alpha hydroxy acid (AHA) is also used as a skin bleacher, but its biochemical mechanism is unclear. Side effects may include sun sensitivity, skin redness, thickening, or itching. Low concentrations may be used in cosmetics. Kojic acid is an effective lightener in some studies and is also allowed to be used in cosmetics. Side-effects, however, include redness and eczema.

Glutathione is the most common agent taken by mouth in an attempt to whiten the skin. It may also be used as a cream. It is an antioxidant normally made by the body. Whether or not it actually works is unclear as of 2019. Due to side effects that may result from intravenous use, the government of the Philippines recommends against such use.

One 2017 review found tentative evidence of the benefit of tranexamic acid in melasma, while another 2017 review found that evidence to support its use was insufficient. Azelaic acid may be a second-line option for melasma. Several types of laser treatments have been used in melasma with some evidence of benefit. Reoccurrence, however, is common and certain types of lasers can result in more pigmentation.

Side effects
Skin lightening creams have commonly contained mercury, hydroquinone, and corticosteroids. Because these compounds can induce both superficial and internal side effects, they are illegal to use and market in multiple nations. However, various chemical studies indicate that these compounds continue to be used in sold cosmetic products, though they are not explicitly declared as ingredients.

Prolonged usage of mercury-based products can ultimately discolor the skin, as mercury will accumulate within the dermis. Mercury toxicity can cause acute symptoms such as pneumonitis and gastric irritation. However, according to a study by Antoine Mahe, and his colleagues, mercurial compounds can also contribute to long-term renal and neurological complications, the latter of which includes insomnia, memory loss, and irritability.

Other studies have explored the impact of hydroquinone exposure on health. Hydroquinone rapidly absorbs into the body via dermal contact; long-term usage has been found to cause nephrotoxicity and benzene-induced leukemia in the bone marrow. A study by Pascal del Giudice and Pinier Yves indicated that hydroquinone usage is strongly correlated with the development of ochronosis, cataracts, patchy depigmentation, and contact dermatitis. Ochronosis can subsequently lead to lesions and squamous cell carcinomas. While hydroquinone has not been officially classified as a carcinogen, it can metabolize into carcinogenic derivatives and induce genetic changes in the form of DNA damages.

Additionally, corticosteroids have become some of the most commonly incorporated lightning agents. Long-term usage over large areas of skin may promote percutaneous absorption, which can produce complications such as skin atrophy and fragility, glaucoma, cataracts, edemas, osteoporosis, menstrual irregularities, and growth suppression. A 2000 study performed in Dakar, Senegal indicated that chronic usage of skin lighteners was a risk factor for hypertension and diabetes. 

Chemically lightened skin is also more highly susceptible to sun damage and dermal infection. Long-term users of skin bleachers can easily develop fungal infections and viral warts. Pregnant users may also experience health complications for both themselves and their children.

Rate of Usage
According to Yetunde Mercy Olumide, advertisements for skin lighteners often present their products as stepping stones to attain greater social capital. For example, representatives of India's Fair & Lovely cosmetics asserted that their products allowed for socioeconomic mobility, akin to education.

Skin whiteners typically range widely in pricing; Olumide attributes this to the desire to portray whitening as financially accessible to all. These products are marketed to both men and women, though studies indicate that, in Africa, women use skin bleachers more than men do. A study by Lester Davids and his colleagues indicated that nations in Africa present high rates of usage for skin bleachers. Though many products have been banned due to toxic chemical compositions, Davids found that regulating policies are often not strictly enforced.

In India, the sales of skin lightening creams in 2012 totaled around 258 tons, and in 2013 sales were about US$300 million. By 2018, the industry for lightening cosmetics in India had achieved a net worth of nearly $180 million and an annual growth rate of 15%. 

As of 2021, Fair & Lovely is changed to Glow & Lovely and there are other brands, who have also changed their logo and motto as the government has restricted the usage of claims in the cosmetics industry.

Motivations
Historian Evelyn Nakano Glenn attributes sensitivities to skin tone among African Americans to the history of slavery. Lighter-skinned African Americans were perceived to be more intelligent and skilled than dark-skinned African Americans, who were relegated to more physically taxing, manual labor.

Studies have additionally linked paler skin to achieving various forms of social standing and mobility. A study by Kelly Lewis and her colleagues found that, in Tanzania, residents choose to bleach their skin to appear more European and impress peers and potential partners. Both advertisements and consumers have suggested that whiter skin can enhance individual sexual attractiveness. Sociologist Margaret Hunter noted the influence of mass-marketing and celebrity culture emphasizing whiteness as an ideal of beauty. A study by Itisha Nagar also revealed that lighter skin tones in both men and women in India improved their prospects for marriage.

Skin whitening is a major issue throughout Asia. In South Korea, light skin is considered an ideal of beauty, and most South Koreans believe that having paler skin is the only way to look beautiful. In South Korea, skin whitening is a multi-billion-dollar industry. The K-pop and K-drama industries are saturated with fair-skinned celebrities, some of whom serve as brand ambassadors and beauty ideals. The trend of having fairer skin can be traced back to several centuries, where white skin was a sign of being high in the social hierarchy since those who were wealthier did not have to work outside in the fields. The increasing popularity of K-pop and K-beauty has driven the skin whitening trend elsewhere in Asia, especially in poorer countries like Thailand, where many have begun to use unsafe skin-whitening products.

Other motivations for skin whitening include desiring softer skin and wanting to conceal discolorations arising from pimples, rashes, or chronic skin conditions. Individuals with depigmenting conditions such as vitiligo have also been known to lighten their skin to achieve an even skin tone. According to local analytics in Asian countries, people with white skin are more likely to get more opportunities over brown or brownish skin. It is advised to use natural ways to get clear and fair skin instead of using chemicals.

Mechanism of Action
Skin whitening agents work by reducing the presence of melanin pigment in the skin. To accomplish this, there are several possible mechanisms of action:

  1. Inhibition of the activity of tyrosinase: The catalytic action of tyrosinase is inhibited by the skin whitening agent.
    1. Inhibition of the expression or activation of tyrosinase: The antimelanogenic agent causes less tyrosinase to be generated or prevents tyrosinase from being activated to its functional form.
    2. Scavenging of the intermediate products of melanin synthesis.
    3. Preventing the transfer of melanosomes to keratinocytes.
    4. Directly destroying existing melanin.
    5. Destroying melanocytes: Some compounds are known to destroy melanocytes; this mechanism of action is often used to remove the remaining pigmentation in the case of vitiligo.

History
Early skin whitening practices were not well-documented. According to anthropologist Nina Jablonski, these practices did not become publicized until famous figures, such as Cleopatra, and Queen Elizabeth began to use them regularly. Cosmetic formulas initially spread from continental Europe and China to Britain and Japan, respectively. Various historians argue that, across cultures, skin lightening became a desirable norm due to implications of wealth and purity.

Asia
Skin lightening practices had achieved great importance in East Asia as early as the 16th century. Similar to early European cosmetics, white makeup was reported to cause severe health problems and physical malfunctions. In Japan, samurai mothers who used lead-based white paint on their faces often had children who exhibited symptoms of lead toxicity and stunted bone growth. Japanese nobility, including both men and women, often applied lead powder to their faces before the Meiji restoration. Following the Meiji restoration, men and women reserved white lead makeup and traditional attire for special occasions. In China, Korea, and Japan, washing one's face with rice water was also practiced, as it was believed to naturally whiten skin. Historians also noted that as East Asian women immigrated to the United States, immigrant women engaged in skin lightening more frequently than women who did not immigrate.

Nina Jablonski and Evelyn Nakano Glenn both assert that skin whitening in many South and Southeast Asian nations such as the Philippines grew in popularity through these nation's histories of European colonization. Multiple studies find that preferences for lighter skin in India were historically linked to both the Indian caste system and centuries of outside rule by light-skinned nations. In the Philippines and many Southeast Asian countries, lighter skin was associated with higher social status. Historians indicate that the social hierarchies in the Philippines encompass a spectrum of skin tones due to intermarriage between indigenous populations, East Asian settlers from Japan and China, and European and American colonists.

Europe
Skin whitening practices have been documented in ancient Greece and Rome. Bleaching cosmetics often incorporated white lead carbonate and mercury as lightning agents. These products were ultimately known to cause skin erosion.

Skin whitening was frequently documented during the Elizabethan era. Queen Elizabeth's own usage of skin lighteners became the prominent standard of beauty. Additionally, according to medieval historians, light skin was an indicator of aristocracy and higher socioeconomic class, as laborers were more frequently exposed to outdoor sunlight. Men and women lightened their skin superficially and chemically, using white powder and Venetian ceruse, respectively. Venetian ceruse consisted of a lead and vinegar mixture, known to cause hair loss, skin corrosion, muscle paralysis, tooth deterioration, blindness, and premature aging. Venetian ceruse was also reported as a source of lead poisoning. Lye and ammonia, found in other skin whiteners, compounded the toxic effects of lead. Other practices done in the name of skin whitening included washing one's face in urine and ingesting wafers of arsenic.

United States
According to scholar Shirley Anne Tate, skin whiteners in the United States initially were predominantly used by white women. European immigrants introduced recipes for cosmetic skin lighteners into the American colonies, where they eventually evolved to incorporate indigenous and West African herbal traditions. Skin whitening grew in popularity in the 1800s, as white women in the United States began to emulate the skin-whitening practices performed by those in Europe. As such, American women similarly used ceruse, arsenic wafers, and products that contained toxic dosages of lead and mercury.

Skin lightening was often not well-received; women who used skin whiteners were described as artificial, while men who used skin whiteners were described as overly effeminate. Despite this reception, skin whitening remained a popular practice. Historians also note that advertisements for skin whiteners in the 20th century often published criticism of black women who used skin bleachers, arguing that they appeared unnatural and fraudulent.

In the 1930s, tanned skin became popular among white women as a new symbol of wealth; some historians assert that industrialization had created indoor settings for labor, causing tanned skin to be associated more with sunbathing, travel, and leisure. The growth of the Black is Beautiful movement in the 1960s, combined with greater awareness of potential health hazards, also temporarily slowed the sale and popularity of skin bleachers. However, by the 1980s, paler skin once again became more desirable, as tanning became linked to premature aging and sun damage.

Latin America
Skin whitening practices have also been well documented in South America and the Caribbean. Sociologists such as Jack Menke noted that early skin lightening practices among indigenous women were motivated by the attentions of conquistadores. Recovered journals from women in Suriname indicated that they used vegetable mixtures to lighten their skin, which produced painful side effects.

Various studies have linked the prevalence of skin whitening in Latin American nations to their histories and legacies of colonization and slavery. Witness accounts were observed to treat their skin with cashew nut oil, which burned the external layers of skin.

Skin whitening practices grew in popularity, partly as a consequence of blanqueamiento in Latin America. The ideologies behind blanqueamiento promoted the idea of social hierarchy, based on Eurocentric features and skin tone.

Africa
Records indicate prominent usage of skin lighteners in South Africa beginning in the 20th century. Historians suggest that this may be associated with the passage of the Colored Labor Preference Act, in 1955. Skin lighteners in South Africa were first marketed to white consumers, then eventually to consumers of color. Initially, skin whitening was typically practiced by rural and poor South African women; however, studies indicate that the practice has become increasingly prevalent among black women with higher incomes and levels of education.  Historian Lynn Thomas attributes the initial popularity of these skin whiteners to the socially desired implications of limited outdoor labor, sexual relationships with lighter-skinned partners, and lighter-skinned heritage.  Starting in the 1970s, the South African government established regulations for skin whitening products, banning products that contained mercury or high levels of hydroquinone. By the 1980s, critiques of skin whitening had become incorporated into the anti-apartheid movement, given skin whitening's adverse consequences on health and its social implications of colorism.

In Ghana, preferences for lighter skin had been documented beginning in the 16th century. Shirley Anne Tate attributes this to the aesthetics and statuses promoted during the period of colonial rule, citing the social influence and wealth of notable Euro-Ghanaian families. Other studies found that, in Tanzania, skin bleaching has been regularly practiced by the middle and working classes, as light skin was perceived to facilitate social mobility.

Skin whitening practices in several other African countries increased following the onset of independence movements against European colonial rule. Maya Allen attributed this to the increased flow of European products and commercial influence into colonized regions. Several historians have suggested that the increased prevalence of skin whitening in "the Global South" is potentially tied to both pre-colonial notions of beauty and post-colonial hierarchies of race.

References;
1. Skin Whitening

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