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

Skin-lightening products can be dangerous, but users aren’t always aware of the risks, a new study finds.

To conduct the study, researchers sent an anonymous 19-question survey to individuals with skin of color in the U.S. asking about their demographics, colorism attitudes, skin tone satisfaction, and skin-lightening habits. Of 455 individuals who completed the survey, 238 were Black, 83 were Asian, 84 were multiracial, 31 were Hispanic, 14 were American Indian or Alaskan Native, and five identified as other. 

The use of skin-lightening agents was reported by 21.3% of respondents, with 75.3% of these respondents using them to treat a skin condition such as acne, melasma, or hyperpigmentation. The others were using the agents for general skin lightening. 

Only 22.6% (22/97) of skin lightener users consulted a medical provider before using the products. Forty-four participants (45.4%) were unaware of their skin-lightener product ingredients, and 35.1% (34/97) reported using hydroquinone-based products. 

“The most surprising finding was the lack of awareness of ingredients in products being purchased over the counter and their potential detrimental effects,” says lead investigator Roopal Kundu, MD, founder and director of the Northwestern Medicine Center for Ethnic Skin and Hair, in a news release. “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.” Dr. Kundu is also a professor of dermatology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine board-certified dermatologist. 

In 2020, the US Food and Drug Administration (FDA) received reports of serious side effects from the use of skin-lightening products containing hydroquinone, including skin rashes, facial swelling, and exogeneous ochronosis. The FDA advised consumers not to use these products due to the potential harm they may cause.
Colorism is behind skin lightening

The study participants who used skin lighteners perceived stronger colorism in their lives than those who did not use the products, according to the study.  Colorism is the system of inequality that views lighter skin as more beautiful and advantageous.

“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,” Dr. Kundu says. “The belief is that having lighter skin is tied to personal and professional success.”

Most of Dr. Kundu’s patients interested in skin lightening want to do so to even out skin tone due to a skin disease. But a fourth of study participants wanted to do general skin lightening. One of Kundu’s patients recently told her his goal was to completely lighten his skin. “I had to tell him that is not something we can do,” Dr. Kundu says. “We weren’t going to globally lighten his skin color.”

“As dermatologists, we hope to understand the cultural and societal influences that impact skin health and treatment of skin disease,” Kundu says. “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.” 

The study appears in the International Journal of Women’s Dermatology.