What is Skin Bleaching?

Skin bleaching, which is also known as skin lightening or skin whitening, is a worldwide multibillion-pound/dollar business. Figures from 2017, show that the global skin lightening industry was worth $4.8bn (£3.4bn); this year (2022) the forecast is $6.5bn and it is projected to grow to $8.9bn by 2027. (Source Statista)

The Guardian newspaper cited a World Health Organization (WHO) study which found that skin lightening creams are regularly used by:

• 40% of Chinese women.
• 61% of women in India.
• 77% of women in Nigeria.
• 59% of women in Togo.
• 35% of women in South Africa.
• 27% of women in Senegal.
• 25% of women in Mali.

And a study by the International Journal of Women’s Dermatology found that:

• Throughout the Indian subcontinent, half of all spending in the skincare industry is on skin lightening creams.
• In Southeast Asia, the use of whitening agents is expanding, with recent studies estimating one in two Filipino women use skin lightening products.
• 43.3% of Saudi women, 60% of Jordanians, and possibly higher usages of skin lightening products in other Middle Eastern countries.
• At the Santa Casa de Misericórdia of Rio de Janeiro, Brazil, approximately 50% of all patients presenting to the clinic request topical treatments or procedures to lighten the skin.

A study observing skin bleaching among women of African descent in New York City found that over 30% of patients were bothered by their skin’s natural appearance, with 25% of patients embarrassed about their colour, feeling a restricted sense of freedom.

In a survey by the British Skin Foundation, it was found that:

• A third of those using skin lightening products did so because they believed lighter skin was more attractive.
• A further 11% cited pressure from both family and friends to get lighter skin.
• Another 11% explained that their culture deemed lighter skin as more attractive.
• Those surveyed discussed side effects such as rashes, skin thinning and uneven skin tone – but 21% carried on using the products anyway.
• 5% said they had used a skin lightening product on a child.

What is skin bleaching?

Skin bleaching is a cosmetic process using synthetic or natural substances or mixtures, or treatments such as lasers or chemical peels, to physically lighten a person’s skin tone, either to reduce dark areas of skin or to achieve an overall paler skin tone.

The history of skin bleaching

The history of skin bleaching probably has its roots in ancient civilisations, where honey mixed with olive oil was used by the ancient Egyptians, Greeks and Romans to lighten their skin in their quest for distinction through physical appearance.

The preference for white skin, even among men, has existed in many parts of Asia for over a thousand years. In the Heian period in Japan (794 to 1185 AD) and in the Ming period in China (1368–1644), handsome men were described as having white or pale skin. Also, Japanese and Chinese women have been documented using rice powder and white lead to bleach their skin.

On the Indian sub-continent, a light complexion has been associated with power, status and beauty for centuries. Various European settlers and traders, including the French, Portuguese and Dutch, started arriving from the 15^th century. These foreign “visitors” were of relatively fair complexion, and many claimed to be superior to the indigenous population, so skin bleaching represented a way to achieve the social status reserved for white people.

Later in the 17^th century, English traders from the East India Company arrived in East and Southeast Asia, and in India, which was later colonised by the British. British rule had a similar effect of perpetuating the notion that light skin is associated with a higher social standing, a notion that despite independence in 1947, is still seen today, as a 2018 article “A Study on Skin-Color Bias in Arranged Indian Marriages” points out.

It states that the practice can be traced back to white rule, which “led to internalisation of superiority and power of the white skin and inferiority and powerlessness of the dark skin”. The film industry in India also contributes to the continued fascination with fair skin and most leading Bollywood stars are pale-complexioned.

However, attitudes towards the practice of skin bleaching are changing in India and also amongst the wider Asian diaspora. Bollywood superstars, who are known to endorse skin-lightening products, have been publicly criticised for helping to perpetuate a racial hierarchy where whiteness is considered to be desirable, while other skin tones are considered to be abnormal, and unattractive and needing to be changed.

In parts of precolonial Southern Africa, some people used mineral and botanical preparations to brighten, rather than to whiten or lighten, their skin and hair. But it was the colonisation of the continent by Europeans from countries such as Germany, France, Belgium, Spain, Portugal, Italy and Britain that saw skin bleaching become a phenomenon in African counties.

During the era of the trans-Atlantic slave trade, skin colour and associated physical differences were used to distinguish enslaved people from those who were free, and to justify the former’s oppression. Within this colourist political order, some sought to whiten and lighten their complexions, and the practice travelled across the Atlantic to America and to the Caribbean.

In apartheid South Africa, the trade was especially robust. Skin lighteners ranked among the most commonly used personal products in black urban households. During the 1980s, activists inspired by Black Consciousness and the sentiment “Black is Beautiful” teamed up with concerned medical professionals to make opposition to skin lighteners part of the anti-apartheid movement.

In the early 1990s, activists convinced the government to ban all cosmetic skin lighteners containing known depigmenting agents, and to prohibit cosmetic advertisements from making any claims to “bleach”, “lighten” or “whiten” skin. This prohibition was the first of its kind and the regulations immediately closed the in-country manufacture of skin lighteners.

From around Elizabethan times through to the early 20^th century in many European societies, light skin was a mark of class distinction. Untanned skin was a symbol of the privileged classes who didn’t perform any outdoor work.

Darker skinned people were looked down on because they were of the labouring class that worked out in the sun. However, in the 1920s and 1930s many white consumers swapped skin lighteners for tanning lotions, as time spent sunbathing and playing outdoors became a sign of a healthy and leisured lifestyle. Seasonal tanning embodied new forms of white privilege.

Skin bleaching is still widely practised everywhere in the world, including in:

• The United States.
• Southeast Asia.
• Parts of Africa including Ghana and Nigeria.
• Throughout the Caribbean.
• On the Indian sub-continent.
• The UK.

However, worldwide the attitude towards skin bleaching is changing, albeit slowly, particularly in light of the Black Lives Matter (BLM) movement and the Dark is Beautiful Campaign. Following the remarkable success of the global blockbuster movie Black Panther, which featured a predominantly black cast, a growing number of young Africans are taking pride in their complexions and are trying to put an end to skin colour bias.

How skin bleaching works

Skin bleaching procedures work by reducing the concentration or production of melanin in the skin. Melanin is the pigment that gives skin its colour and helps protect it from the sun. People with dark skin have more melanin. Hormones, sunlight and certain chemicals also affect melanin production.

The popular skin lightening techniques or methods include the following:

• Skin bleaching including creams, pills, lotions.
• Hydroquinone treatment.
• Glutathione treatment.
• Chemical peeling.
• Microdermabrasion.
• Laser treatment.
• Cryosurgery.

Topical treatments, which are applied onto the skin, are also known as skin whiteners, bleaching creams or serums, and they work by reducing melanin pigmentation in the skin. Common topical bleaching creams and lotions have historically contained hydroquinone, corticosteroids and mercury compounds.

They are normally used for:

• Improving the appearance of acne and other types of scaring.
• Correcting discoloration due to hormonal changes or age spots, also known as liver spots.
• Bleaching out freckles.
• Improving the appearance of melasma – this is a common and harmless skin condition characterised by brown or blue-grey patches or freckle-like spots. It is often called the “mask of pregnancy” as 15% to 50% of pregnant women get it. Melasma happens because of the overproduction of the cells that make the colour of your skin. Women are more likely to get melasma than men: about 10% of those who get melasma are men, 90% are women.
• Lightening naturally occurring dark skin.

For some skin conditions, powerful skin lightening creams are available on the NHS on prescription from a doctor. These usually contain one or both of the following medicines, hydroquinone and/or corticosteroids such as hydrocortisone.

A laser can also be used to lighten blemishes or dark patches of skin. Laser skin lightening may work for some people, while for others it may not have any effect, or the skin lightening may only be temporary. Laser skin lightening works by either removing the outer layer of skin or damaging the cells that produce melanin.

A skin test should be done on a small area of skin to see how it reacts before the procedure starts and, if there are no problems, the first session will probably take place a few weeks later. A local anaesthetic cream may be used to numb the skin beforehand, as some people may get a stinging or pricking sensation during the procedure.

Laser sessions will usually last around 30 minutes to an hour, a jet of cold air may be blown onto the skin to keep it cool during the treatment and some people describe the treatment sensation as feeling like a rubber band is snapping against the skin.

After a session, people are advised to take painkillers, such as paracetamol, if they have any discomfort and to hold an ice pack wrapped in a towel against the skin to reduce any swelling.

Following any skin lightening treatment, it is crucial that sun cream is applied daily to the treated area for at least 6 months to protect it from the aggravating effects of the sun as the skin will have become more fragile.

What are the side effects from skin bleaching?

Most skin bleaching products are not regulated and as with other cosmetic procedures it can sometimes go wrong.

There are risks and side effects of using skin bleaching creams or serums, and these include:

• Skin irritation and inflammation.
• Itchy and flaky skin.
• Swelling.
• Burning or stinging sensation.
• Skin thinning.
• Scarring.
• Visible blood vessels in the skin.
• Skin turning dark or too light.
• Kidney, liver or nerve damage.
• If used during pregnancy, possible abnormalities in a newborn baby.

Skin bleaching creams that contain corticosteroids can cause steroid acne, a common side effect of steroid use. Some skin lightening products are known to contain mercury, and although mercury has been banned as an ingredient in skin lightening products in many countries, these products are still being sold both online and in some stores. Ingesting mercury, whether through swallowing or through the skin, can cause mercury poisoning.

The signs and symptoms of this include:

• Numbness.
• High blood pressure.
• Fatigue.
• Swelling around the eyes.
• Swollen feet and ankles.
• Loss of appetite.
• Sensitivity to light.
• Neurologic symptoms, such as tremors, memory loss and irritability.
• Foamy urine.
• Kidney failure.

Since traditional lightening agents come with some serious potential side effects, other ingredients are now being used instead.

These include:

• Tretinoin (retinoic acid) – This is commonly used for its anti-ageing effects on the skin and for acne, but it also helps lighten skin. Pregnant women should not use it because it may cause harm to the foetus.
• Glutathione – This is an antioxidant and is used in cancer treatment. It is a popular skin lightener in some countries, but the safety and effectiveness of glutathione have not been evaluated enough to formally recommend its use as a lightener.

Newer alternatives that may have fewer or less serious side effects include:

• Alpha hydroxy acid (AHA).
• Niacin (B3) and niacinamide.
• Arbutin and its derivatives kojic acid and nicotinamide.
• Vitamin C.
• Vitamin E.
• Liquorice extract.
• Azelaic acid.
• N-acetyl glucosamine.

Although skin lightening through laser treatments cannot produce “perfect” skin, it may improve the appearance of the skin.

However, as with the topical treatments, there are potential risks and side effects of laser skin lightening including:

• Crusting.
• Blistering.
• Redness and swelling.
• Skin infection.
• Bruising.
• Scarring.
• Skin turning darker or too light.
• Reactivating herpes cold sores.
• Bacterial infection.

There are a number of products on the market that can be taken orally (by mouth) to lighten skin. Although they currently appear to be effective and safe, more research is needed to determine if they are safe for all people or whether there are adverse effects when taken for longer periods of time.

Using skin bleaching agents over large areas of skin can cause premature ageing of the skin by making the skin more fragile. Having fragile, damaged skin also increases the risk of skin cancer. Historically, skin cancer has not been as common among Black people because of melanin, so when a person uses a chemical to stop the body from making the melanin, there are health implications, perhaps one reason for the increase in skin cancer now seen amongst Black and Brown populations.

If you experience any complications following any skin lightening procedure such as those described above, if you have received this treatment from an NHS or commercial clinic, it is best in the first instance to go back to the practitioner who treated you. If this is not possible, or if you have administered the treatment yourself at home, go to your GP or contact the NHS 111 service, or if you experience severe symptoms that need urgent medical attention go to A & E.

What are the benefits from skin bleaching?

There is no physical health benefit to skin bleaching – the benefits are purely aesthetic – although some might say that there may be some mental health benefits if by lightening their skin, the person feels better about themselves and their appearance; however, the need to bleach the skin may be masking deeper mental health issues in that person.

The results of skin bleaching treatments are not guaranteed or long term, and there is evidence that skin lightening can result in serious side effects and complications such as those described above.

If skin bleaching is used at all, it is best used to lighten specific dark spots or small areas of discoloured skin such as:

• Freckles.
• Pigmentation left from acne blemishes.
• Age spots.
• Spots and melasma (darkened areas due to sun exposure).

Can you bleach your own skin?

The use of skin lightening products is popular in the UK among women and some men, particularly from African, Asian, Latin American and Caribbean backgrounds. However, many home use skin creams, skin toners, bleaching and whitening agents are harmful and are banned from sale, although some do find their way on to the market.

Activists recently targeted Amazon for the sale of mercurial skin lighteners and sent a petition with 23,000 signatures to the company’s Minnesota office for the removal of these products from their site.

Dermatologists recommend anyone considering skin lightening consult with either their GP or with a registered clinician rather than attempt the process at home.

Why would someone bleach their skin?

There are a variety of reasons why people bleach their skin; the main reason is a desire to have a lighter skin. This desire is rooted in complex social, cultural and historical factors, some of these have been described above. It is a practice that is often reinforced by successful celebrities or social media influencers.

However, other reasons for people to bleach their skin include:

• To remove blemishes such as melasma, freckles, scarring, etc.
• To lighten facial hair, when facial hairs are lightened, they are matched with skin and the skin then looks fairer.
• Body dysmorphia.

Is skin bleaching legal?

Whilst in the UK, skin bleaching itself is not illegal, there are many skin bleaching products that are. It is illegal to sell products in the UK without the supplier’s name and address and a list of the ingredients, so if a product is missing these key pieces of information then they may be illegally imported and could contain banned ingredients.

The EU has similar rules, nevertheless, illegal skin lightening products do manage to make their way into the UK. These illegal skin whitening creams can come from around the world including from Pakistan, the Middle East and the Caribbean to name just a few and can sometimes be bought under the counter in beauty shops or online.

Trading Standards authorities are responsible for enforcing consumer protection laws such as the safety regulations for cosmetics and skin creams, and are active in seizing banned products and prosecuting businesses. Where steroid-based creams are found, the Medicines and Healthcare Products Regulatory Agency (MHRA) will also be responsible for prosecuting as the products can be classed as medicines.

Trading Standards officers carry out undercover test purchasing to check retailers are not selling illegal items and carry out spot checks at businesses. In 2014–15, a special project was undertaken where samples were bought in London shops, and health and beauty salons, and these were tested for harmful chemicals.

Of 122 samples, 25 (20.5%) contained hydroquinone; and from 87 samples, 33 (37.9%) contained mercury, of which 14 (16% of total) were found to have significantly high levels. Thousands of products were subsequently seized and prosecutions followed. Over £100,000 in fines and costs were imposed by the courts, as well as suspended prison sentences.

In 2018, BBC undercover journalists visited 17 shops across London, Leeds, Birmingham and Manchester to see how many illegal products they could purchase. Six of these shops had been previously prosecuted for selling the creams. A total of 13 shops were found to sell products containing illegal substances. Of the prosecuted shops, four out of the six resold banned products.

In Africa, South Africa became the first country in the world to ban skin bleaching products and was recently joined by Rwanda, Cote d’Ivoire, Tanzania, Kenya and Ghana.

In South Korea, over-the-counter hydroquinone has been banned by federal regulations; however, imported and online cosmetic products containing hydroquinone, mercury and steroid agents are available.

In Jamaica, under the Food and Drug Act, persons found guilty of selling and distributing skin lightening products that are not approved by the Ministry of Health, can be fined $50,000 per offence or be imprisoned.

In the USA, over-the-counter (OTC) skin lightening products must be approved by the Food and Drug Administration (FDA) prior to sale.

Final thoughts

The UK market for skin bleaching products is still growing, and there are many unscrupulous sellers of products which promise much, but either do not deliver what they promise, or are either dangerous to skin or banned for other reasons, possibly because of the ingredients used in their production.

If you think that you have been using any of the banned skin lightening products then stop using these products immediately and consult your doctor if you are concerned about any skin damage or health problems.

If you are aware that someone or a business is selling illegal skin lighteners you should contact Citizens Advice in confidence on 03454 04 05 06; they will report matters to your local Trading Standards for further investigation.