Earlier this year media reports caught our attention that hundreds of skin lightening (or skin bleaching) creams were seized by Heathrow airport officials preventing them from entering Britain. These products originated from Nigeria and contained an ingredient Hydroquinone, which causes thinning of skin and is potentially carcinogenic. This is not a stand-alone incident; there is continuous selling of skin lightening agents even in countries that have legislated against its sale.

Misuse of skin- lightening agents is a global phenomenon, more prevalent in people of African, Asian, Caribbean, and the Middle East origin. Expatriates from these regions to Europe and USA also have high rates of using these creams.  A survey conducted by WHO in 2011, showed that more than 70 % of Nigerian use skin lightening creams.

Skin-lightening (or “skin-bleaching”) agents are important compounds used in the management of hyperpigmentation conditions, such as melasma and post-inflammatory hyperpigmentation. However, misusing these agents for lightening natural skin color, results in multiple short- and long-term complications. Other than hydroquinone mentioned earlier other harmful agents that these fairness creams contain are Mercury and corticosteroids. Research shows that use of inorganic mercury in skin products can cause local skin effects such as skin irritation, discoloration, and scarring and increase susceptibility to bacterial and fungal infections. Systemic effects include kidney damage and neuro-psychological effects including depression, anxiety, psychosis and peripheral neuropathy.

WHO report highlights another aspect that mercury in these soaps and creams gets mixed in  water waste  and may enter human body through contaminated food ,especially contaminated  fish is a risk for pregnant women it may cause  neurological problems in the offspring in later age.

Use of skin lightening agents qualifies as a matter of high public health concern, firstly due to its serious adverse effects and the number of people involved, and secondly, it is amenable to preventive strategies.

Why people use these skin lightening products inspite of harmful effects is partly rooted in culture beliefs and practices in these societies.  Having a fairer skin is synonymous for beauty. Media also plays a pivotal role in promoting these concepts, advertisements promotes use of skin lightening creams  by projecting that having a fairer skin is the solution  for more confident, for  better marriage prospects, and a better  job. More importantly people are not aware of these harmful effects. Research efforts by WHO and other public health organization have well-established adverse effects of these creams since the decade of the 90s. But this research knowledge failed to reach a common consumer residing in Africa, Asia or even in developed countries. We can understand this phenomena through example of smoking, empirical evidence started pouring in 1960 and 70s about its detrimental health effects, strengthened by studies like “Framingham study”- one of the longest running cohort studies. However, translating this knowledge into people’s behaviour and practice required massive awareness raising efforts involving all stake holders including, state, health organizations, academia and media. Similar efforts are required for skin lightening agents and WHO, entrusted with the mandate to improve people’s health, must take a lead in this endeavour.

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