Skin whitening

Skin whitening, also known as skin lightening and skin bleaching, refers to 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 have been shown to be effective in skin whitening, while some have proven to be toxic or have questionable safety profiles. This includes mercury compounds which may cause neurological problems and kidney problems.[1]

Skin whitening
A 19th century advertisement for arsenic wafers in the United States
Other namesSkin lightening, brightening, depigmentation, bleaching

In a number of African countries, between 25 and 80% of women regularly use skin whitening products.[2] In Asia, this number is around 40%.[2] In India, specifically, over half of skin care products are sold to whiten skin.[3][2]

Efforts to lighten the skin date back to at least the 1500s in Asia.[4] While a number of agents—such as kojic acid and alpha hydroxy acid—are allowed in cosmetics in Europe, a number of others such as hydroquinone and tretinoin are not.[4] While some countries do not allow mercury compounds in cosmetics, others still do, and they can be purchased online.[2]

Use
Skin whitening products from the Japanese brand Shiseido

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.[4] These agents however are not allowed in cosmetics in Europe due to concerns of side effects.[4] Attempts to whiten large areas of skin may also be carried out by certain cultures.[4] This may be done for reasons of appearance, politics, or economics.[4]

Many skin whiteners contain a form of toxic mercury as the active ingredient.[2] Their use however may harm a person's health and are illegal in many countries.[2]

Hydroquinone is a commonly used agent in skin whiteners, though the European Union banned it from cosmetics in 2000.[5] It works by decreasing melanin production.[5] Tretinoin, also known as all-trans retinoic acid, may be used to whiten specific areas.[4] It may be used in combination with steroids and hydroquinone.[4][4]

Alpha hydroxy acid (AHA) is also used as a skin bleacher, but its biochemical mechanism is unclear.[4] Side effects may include sun sensitivity, skin redness, thickening, or itching.[4] Low concentrations may be used in cosmetics.[4] Kojic acid has been found to be an effective lightener in some studies, and is also allowed to be used in cosmetics.[4] Side effects however include redness, and eczema.[4][4]

Glutathione is the most common agent taken by mouth in an attempt to whiten the skin.[6] It may also be used as a cream.[6] It is an antioxidant normally made by the body.[6] Whether or not it actually works is unclear as of 2019.[7] Due to side effects that may result with intravenous use, the government of the Philippines recommends against such use.[8]

One 2017 review found tentative evidence of benefit of tranexamic acid in melasma.[9] While another 2017 review found evidence to support its use was insufficient.[10] Azelaic acid may a second line option for melasma.[11] A number of types of laser treatments have been used in melasma with some evidence of benefit.[12] Reoccurrence however is common and certain types of lasers can result in more pigmentation.[12]

Side effects

Skin lightening creams have commonly contain mercury, hydroquinone, and corticosteroids.[13] Because these compounds can induce both superficial and internal side effects, they are illegal to use and market in multiple nations.[13][14] However, various chemical studies indicate that these compounds continue to be used in sold cosmetic products, though they are not explicitly declared as ingredients.[15][1]

Prolonged usage of mercury-based products can ultimately discolor the skin, as mercury will accumulate within the dermis.[16] Mercury toxicity can cause acute symptoms such as pneumonitis and gastric irritation.[16] However, according to a study by Antoine Mahé 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.[1]

Other studies have explored the impact of hydroquinone exposure on health.[13] Hydroquinone rapidly absorbs into the body via dermal contact; long-term usage has been found to cause nephrotoxicity and benzene-induced leukemia in bone marrow.[17] 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.[13] Ochronosis can subsequently lead to lesions and squamous cell carcinomas.[16] 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.[1][17]

Additionally, corticosteroids have become some of the most commonly incorporated lightening agents.[16] 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.[16] A 2000 study performed in Dakar, Senegal indicated that chronic usage of skin lighteners was a risk factor for hypertension and diabetes.[1]

Chemically lightened skin is also more highly susceptible to sun damage and dermal infection.[16][1] Long-term users of skin bleachers can easily develop fungal infections and viral warts.[16] Pregnant users may also experience health complications for both them and their children.[16][1]

Rate of usage

According to Yetunde Mercy Olumide, advertisements for skin lighteners often present their products as stepping stones to attain greater social capital.[18] For example, representatives of India's Fair & Lovely cosmetics asserted that their products allowed for socioeconomic mobility, akin to education.[18] As an industry, skin lightening products are predominantly sold by three major corporations: France-based L'Oreal, Japan-based Shiseido, and United Kingdom-based Unilever.[18]

Skin whiteners typically range widely in pricing; Olumide attributes this to the desire to portray whitening as financially accessible to all.[18] These products are marketed to both men and women, though studies indicate that, in Africa, women use skin bleachers more than men do.[18][19] A study by Lester Davids and his colleagues indicated that nations in Africa present high rates of usage for skin bleachers.[20] Though many products have been banned due to toxic chemical compositions, Davids found that regulating policies are often not strictly enforced.[20]

In India, the sales of skin lightening creams in 2012 totaled around 258 tons, and in 2013 sales were about US$300 million.[21][22] 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%.[23] As of 2013, the global market for skin lighteners was projected to reach $19.8 billion by 2018 based on sales growth primarily in Africa, Asia, and the Middle East.[24]

In the United Kingdom, many skin whiteners are illegal due to possible adverse effects. Such products are frequently still sold even after shops have been prosecuted. Trading standards departments lack resources to deal with the problem effectively.[25]

Motivations

Historian Evelyn Nakano Glenn attributes sensitivities to skin tone among African Americans to the history of slavery.[26] 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.[26]

Studies have additionally linked paler skin to achieving various forms of social standing and mobility.[27][28][29] 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.[28] Both advertisements and consumers have suggested that whiter skin can enhance individual sexual attractiveness.[30] Sociologist Margaret Hunter noted the influence of mass-marketing and celebrity culture emphasizing whiteness as an ideal of beauty.[27] A study by Itisha Nagar also revealed that lighter skin tones in both men and women in India improved their prospects for marriage.[23]

Other motivations for skin whitening include desiring softer skin and wanting to conceal discolorations arising from pimples, rashes, or chronic skin conditions.[28] Individuals with depigmenting conditions such as vitiligo have also been known to lighten their skin to achieve an even skin tone.[31]

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:[32]

Inhibition of tyrosinase
Further information: enzyme inhibitor

Upregulation of tyrosinase caused by tyrosinase inhibitors. Several skin whitening agents, including tyrosinase inhibitors, have been found to cause an increase in the expression of tyrosinase, which by itself would increase melanin synthesis.[33]

Microphthalmia-associated transcription factor (MITF) is the master transcription factor that controls the expression of TYR, TRP1 and TRP2, MART1, PMEL17, and many other important proteins involved in the function of melanocytes.[notes 1] Downregulation of MITF decreases melanogenesis[notes 1] and is a mechanism of action of some skin whitening agents.[34] Various signaling pathways and genetic mutations influence the expression of MITF.[notes 2]

MC1R receptor and cAMP

The melanocortin 1 receptor (MC1R) is a transmembrane and G-protein coupled receptor expressed in melanocytes. MC1R is an important target for the regulation of melanogenesis.[38][39][35] Agonism of MC1R increases the ratio of eumelanin to pheomelanin and increases the generation of melanin overall.

The MC1R and cAMP signaling pathway[38][39][40] starts with the activation of MC1R, which causes activation of adenylyl cyclase (AC), which produces cyclic adenosine monophosphate (cAMP), which activates protein kinase A (PKA), which activates by protein phosphorylation cAMP response element-binding protein (CREB), which upregulates MITF, of which CREB is a transcription factor.

Alpha-melanocyte stimulating hormone (α-MSH), beta-melanocyte stimulating hormone (β-MSH), and adrenocorticotropic hormone are endogenous agonists of MC1R.[37]:1175 Agouti signaling protein (ASIP) appears to be the only endogenous antagonist of MC1R. Synthetic MC1R agonists have been designed, such as the peptides afamelanotide and melanotan II.[38]

Mutations of the MC1R gene correlate and are at least partially responsible for red hair, white skin, and an increased risk for skin cancer in some individuals.[38][41][39][42][43][44][37]:1175

Transfer of melanosomes
See also: human skin § Structure, and epidermis

Within the skin, melanocytes are present in the basal layer of the epidermis; from these melanocytes originate dendrites that reach keratinocytes.[notes 3]

Melanosomes along with the melanin they contain are transferred from melanocytes to keratinocytes when keratinocytes are low in the epidermis.[notes 4] Keratinocytes carry the melanosomes with them as they move towards the surface. Keratinocytes contribute to skin pigmentation by holding the melanin originated in melanocytes and inducing melanogenesis through chemical signals directed at melanocytes.[notes 2] The transfer of melanosomes to keratinocytes is a necessary condition for the visible pigmentation of the skin.[45] Blocking this transfer is a mechanism of action of some skin whitening agents.[34][32]

The protease-activated receptor 2 (PAR2) is a transmembrane and G-protein coupled receptor expressed in keratinocytes and involved in melanocyte transfer.[notes 5] Antagonists of PAR2 inhibit the transfer of melanosomes and have skin whitening affects, while agonists of PAR2 have the opposite effect.[notes 5]

Destroying melanocytes

Some compounds are known to destroy melanocytes; this mechanism of action is often used to remove the remaining pigmentation in cases of vitiligo.[50]

History
An advertisement from the 1930s for Sweet Georgia Brown skin bleaching cream.

Early skin whitening practices were not well-documented.[51] 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.[51] Cosmetic formulas initially spread from continental Europe and China to Britain and Japan, respectively.[51] Various historians argue that, across cultures, skin lightening became a desirable norm due to implications of wealth and purity.[51][52][18]

Asia

Skin lightening practices had achieved great importance in East Asia as early as the 16th century.[51] Similar to early European cosmetics, white makeup was reported to cause severe health problems and physical malformations.[51] 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.[51] Japanese nobility, including both men and women, often applied white lead powder to their faces prior to the Meiji restoration.[53] Following the Meiji restoration, men and women reserved white lead makeup and traditional attire for special occasions.[53] In China, Korea, and Japan, washing one's face with rice water was also practiced, as it was believed to naturally whiten skin.[54][55] 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.[26]

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 nations' histories of European colonization.[54][56] Multiple studies find that preferences for lighter skin in India were historically linked to both the caste system and British, Persian, and Mughal rule.[57][58] In the Philippines, lighter skin was associated with higher social status.[26] Historians indicate that the social hierarchies in the Philippines encompasses a spectrum of skin tones due to intermarriages between indigenous populations, East Asian settlers, and Spanish colonists.[56][59]

Europe

Skin whitening practices have been documented in ancient Greece and Rome.[60] Bleaching cosmetics often incorporated white lead carbonate and mercury as lightening agents.[60] These products were ultimately known to cause skin erosion.[60]

As well, skin whitening was frequently documented during the Elizabethan era.[61] Queen Elizabeth's own usage of skin lighteners became a prominent standard of beauty.[62] 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.[63][64] Men and women lightened their skin superficially and chemically, using white powder and Venetian ceruse, respectively.[65][63] Venetian ceruse consisted of a lead and vinegar mixture, known to cause hair loss, skin corrosion, muscle paralysis, tooth deterioration, blindness, and premature aging.[65][66][64] Venetian ceruse was also reported as a source of lead poisoning.[65][62] Lye and ammonia, found in other skin whiteners, compounded the toxic effects of lead.[62] Other practices done in the name of skin whitening included washing one's face in urine and ingesting wafers of arsenic.[60][64]

United States

According to Shirley Anne Tate, skin whiteners in the United States initially were predominantly used by white women.[62] English immigrants introduced recipes for cosmetic skin lighteners into the American colonies, where they eventually evolved to incorporate indigenous and West African herbal traditions.[62] Skin whitening grew in popularity in the 1800s, as white American women began to emulate the skin-whitening practices performed by white English women.[62] As such, American women similarly used ceruse, arsenic wafers, and products that contained toxic dosages of lead and mercury.[62]

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.[62] Despite this reception, skin whitening remained a popular practice, as it became connotative with notions of racial and socioeconomic superiority.[62][64] Historians also note that advertisements for skin whiteners in the 20th century often associated pale skin with gentility.[67]

According to historian Kathy Peiss, skin whitening among black American women had been documented starting in the mid-nineteenth century.[68] Historians credited the increased marketing of skin whiteners to the culture of the Jim Crow era, as black Americans faced continued social and legal restrictions.[54][69] Cosmetic advertisements directed at black consumers often framed resulting lighter complexions as cleaner and better.[68][59] Simultaneously, however, cosmetic and beauty magazines often published criticisms of black women who used skin bleachers, arguing that they appeared unnatural and fraudulent.[68][59]

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.[64][62] 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.[54] However, by the 1980s, paler skin once again became more desirable, as tanning became linked to premature aging and sun damage.[62][59]

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.[70][71] Recovered journals from women in Suriname indicated that they used vegetable mixtures to lighten their skin, which produced painful side effects.[71]

Various studies have linked the prevalence of skin whitening in Latin American nations to their histories and legacies of colonization and slavery.[72][55][70] Witness accounts in colonial Jamaica reported that women practiced "flaying" and "skinning" on themselves, using astringent lotions to appear lighter.[72] Caribbean creole women were also observed to treat their skin with cashew nut oil, which burned the external layers of skin.[72]

Skin whitening practices grew in popularity, partly as a consequence of blanqueamiento in Latin America.[73] The ideologies behind blanqueamiento promoted the idea of social hierarchy, based on Eurocentric features and skin tone.[74]

Africa

Records indicate prominent usage of skin lighteners in South Africa beginning in the 20th century.[20] Historians suggest that this may be associated with the passage of the Colored Labor Preference Act, in 1955.[75] Skin lighteners in South Africa were first marketed to white consumers, then eventually to consumers of color.[76] 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.[56] 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.[76] Starting in the 1970s, the South African government established regulations for skin whitening products, banning products that contained mercury or high levels of hydroquinone.[77] 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.[77]

In Ghana, preferences for lighter skin had been documented beginning in the 16th century.[72] Shirley Anne Tate attributes this to the aesthetics and statuses promoted through British colonialism, citing the social influence and wealth of notable Euro-Ghanaian families.[72] Other studies found that, in Tanzania, skin bleaching has been regularly practiced by middle and working classes, as light skin was perceived to facilitate social mobility.[78][72]

Skin whitening practices in several other African countries increased following the onset of independence movements against European colonization.[79][80] Maya Allen attributed this to the increased flow of European products and commercial influence into colonized regions.[79] Several historians have suggested that the increased prevalence of skin whitening in "the Global South" is potentially tied to both precolonial notions of beauty and post-colonial hierarchies of race.[67]

See also
  • Anal bleaching
  • Ethnic plastic surgery
  • Depigmentation
  • Xeesal
  • Albinism
  • Hypopigmentation
  • White skin
  • Colorism
  • Shadism
  • Venetian Ceruse – white lead based cosmetic worn by Elizabeth I of England
  • Racial whitening
    • Whiteness in Japanese culture
  • Colonial mentality

Notes

Italics have been preserved whenever they appear in quotations. Text between square brackets are additional notes not present in the source.

  1. "The transcriptional level is the first stage by which the expression of tyrosinase and related melanogenic enzymes may be modulated. Influential in this process, the microphthalmia-associated transcription factor (MITF) is a basic helix-loop-helix leucine zipper transcription factor that regulates melanocyte cellular differentiation as well as the transcription of melanogenic enzymes (tyrosinase, TYRP1 and TYRP2) and melanosome structural proteins (MART-1 and PMEL17) [references omitted]."[32]
  2. Many papers have described the signaling pathways affecting melanogenesis and other functions of melanocytes. The following reviews are suggested reading (all of which are available online at no cost):
    Smit, Vicanova, Pavel (2009).[34] For a description with emphasis on physiology, see Yamaguchi, Hearing (2009)[35] or Kondo (2011).[36] An extensive and detailed review was written by Slominski et al. (2004).[37]
  3. "In the skin, melanocytes are situated on the basal layer which separates dermis and epidermis. One melanocyte is surrounded by approximately 36 keratinocytes. Together, they form the so-called epidermal melanin unit. The melanin produced and stored inside the melanocyte in the melanosomal compartment is transported via dendrites to the overlaying keratinocytes."[34]

    "Each melanocyte resides in the basal epithelial layer and, by virtue of its dendrites, interacts with approximately 36 keratinocytes to transfer melanosomes and protect the skin from photo-induced carcinogenesis. Furthermore, the amount and type of melanin produced and transferred to the keratinocytes with subsequent incorporation, aggregation and degradation influences skin complexion coloration [reference omitted]."[32]

    Wu, Hammer (2014) describe the number of keratinocytes per melanocyte as above 40.[45]
  4. Research about the mechanism of melanosome transfer has been reviewed by Wu, Hammer (2014).[45]
  5. References about PAR2 and its role in skin pigmentation: Kim et al. (2016),[46] Choi et al. (2014),[47] Wu, Hammer (2014),[45] Ando et al. (2012),[48] Ando et al. (2010).[49]

References
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  3. Ryle, Robyn (2016). Questioning Gender: A Sociological Exploration. SAGE Publications. p. PT412. ISBN 9781506325484.
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  15. Desmedt, B.; Courselle, P.; Beer, J. O. De; Rogiers, V.; Grosber, M.; Deconinck, E.; Paepe, K. De (2016). "Overview of skin whitening agents with an insight into the illegal cosmetic market in Europe". Journal of the European Academy of Dermatology and Venereology. 30 (6): 943–950. doi:10.1111/jdv.13595. ISSN 1468-3083. PMID 26953335.
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