Feature

'Mirror mirror on the wall, 
who is the FAIREST of them all?'

Highly topical research by Malangu Ntambwe and team from the National School of Public Health at Medunsa has shown that the quest for 'fairness' in skin colour through the use of skin lighteners is based on many 'unfair' problems and in the long term has very unfair and unhealthy results. He argues that the practise of skin lightening is a public health issue as well as a social and psychological problem.

Malangu Ntambwe

In Southern Africa the largest percentage of people practising skin lightening techniques are African women. Globally however, similar practises are employed by black Americans, Cubans, Jamaicans, Japanese and South Asians.

Why is skin lightening practiced?

There are many reasons why black, dark-skinned people resort to skin lightening and these reasons may be grouped in two kinds.

The first are personal reasons - beauty and its pursuit are universal. The face is viewed as the mirror of the soul, therefore a person's self-esteem, self-hate, self-image is a determinant factor in the quest for beauty. Ignorance is also one of the factors that contribute to this phenomenon since the lack of adequate information is an omnipresent prejudice in all choice-situations. In a recent study in Pretoria the misuse of topical steroid products for skin lightening, not being aware of the side effects was associated with the misuse.

As many studies have revealed, society has a significant impact on the misuse of skin lightening agents. It is known that during slavery years, light-skinned people were often given preferable treatment as compared to their dark-skinned peers. In modern times, studies have indicated that the majority of black men prefer light-skinned women as partners, girlfriends or wives. 

Several authors have stated that these light-skinned women are perceived as attractive, intelligent, moral, sexually more desirable, even chaste; whereas dark-skinned are regarded as mean, evil, stupid, even as not trust-worthy. 

The mass media, particularly television, contributes to this perception by portraying "whiteness or lightness" as a symbol of what is attractive, adorable, desirable, pure, loveable and competent. Lighter skin tone is thus portrayed as a standard for attractiveness and competence. Because physical attractiveness is perceived as associated with social and intellectual competence, integrity, potency, dominance, and even good mental health, it has more bearing on women than men. This explains why women constitute the overwhelming majority of those who practice skin lightening. It has also been reported that women are perceived as more feminine and attractive when they emulate the whiteness standard. 

Even the cosmetic industry promotes products that are designed to help dark-skinned women look "lighter". It is also reported for instance that facial attractiveness is associated with positive evaluation by others and that many African Americans believe that their lighter skinned fellows are more competent. 

Still, in the USA, previous studies have shown that for the same level of education, dark-skinned people earn much less than their peers with lighter skin and thus reinforcing the perception that a lighter skin tone is associated with better economic status.

In a recent study in Pretoria, it was found that besides ignorance, the other predictors of using skin lightening agents were race, that is being Black African, gender, being female, and being advised by a friend to use the products. Across Africa, the widespread availability both in formal and informal markets associated with a disregard to the legal considerations constitute one of the contextual enabling factors to this practice. The findings emphasize the role of environmental factors in encouraging and maintaining this practice. 

Interestingly, level of education, social class, marital and employment status seem to have less influence of the skin lightening practice.

How prevalent is the practise of skin lightening in Africa?

The prevalence of skin lightening reported among those interviewed in Africa shows some disturbing results. In Bamako in Mali, researchers calculated 25% prevalence, while in some studies in Dakar, Senegal, up to 52% prevalence was observed. A study in Pretoria, South Africa revealed up to 35%, while the most disturbing was a study in 2002 which showed up to 77% prevalence in Lagos, Nigeria. 

Some countries are speaking out. The Kenya Bureau of Standards banned several lotions, gels and soaps used for skin lightening that contained hydroquinone. Other African countries are now following. This however does not necessarily stem the practise.

Paying the price

Some of the worst offenders in skin lightening creams are mercury derivatives, hydroquinone and topical steroids. The table below shows some of the unhealthy effects of using skin lightening products containing these agents. Mercury for example is associated with kidney and speech problems.

Harmful effects of skin lightening agents

 
Depending on the products used, the duration and mode of use, skin lightening produces some harmful effects as shown below. Since some of these effects do not appear quickly, and some mimic known disease patterns, they are sometimes confused and misdiagnosed even by health care professionals since patients usually deny using any skin lighteners. It is reported that up to 69% of those who practice skin lightening may suffer from at least one complication.

Public health implications

From the above discussion it is clear that skin lightening has both genetic, behavioural, socioeconomic and environmental determinants. The root cause being a response to a deep-seated need for individuals to cope with the suffering they perceive or experience resulting from social norms. In this sense, skin lightening could be regarded as a disease in the broader definition of health as a 'state of mental and social well-being'.

The multitude of adverse effects that may be experienced by those who practice skin lightening will significantly impact on how they use health care services, diverting valuable resources to care for these conditions.

Skin lightening is not only a psychological and social problem, but also a public health issue that needs to be addressed with targeted interventions
aimed at changing perceptions and educating people on its consequences.

In the next issue, Malangu Ntambwe, explores how these issues can and should be addressed.

More information

References

Adebajo S. (2002). An epidemiological survey of the use of cosmetic skin lightening cosmetics among traders in Lagos, Nigeria. West African Journal of Medicine, 21(1), 51-55.

Alfiee MB. (1998). A model for differential perceptions of competence based on skin tone among African Americans. Journal of Multicultural Counselling and Development 26(4):294-322)

Ashikari M. (2003). Urban middle-class Japanese women nad their white faces: gender, ideology, and representation. Ethos 31(1):3-25.

Bond S, Cash TF. (1992). Black Beauty; Skin color and body images among African-American college women. Journal of Applied Social Psychology 22:874-888.

Boyle J, Kennedy CT.(1986). Hydroquinone concentrations in skin lightening creams. British Journal of Dermatology,114(4), 501-504.

Canizares R. (1990). Cuban racism and the myth of the racial paradise.Ethnic Studies Report 8(2):27-32.

Christopher A. (2003). Skin bleaching, self-hate, and Black identity in Jamaica. Journal of Black Studies 33(6):711-18.

Del Guidice P, Yves P.(2002). The widespread use of skin lightening creams in Senegal: a persistant public problem in West Africa. International Journal of Dermatology, 41(2), 69-72.

De Beaufort I, Bolt I, Hilhorst M, and Wijsbek H. Beauty and the Doctor. Final Report of a European Project. European Commission.

Diamond G, Zalups RK. (1998). Understanding renal toxicity of heavy metals. Toxicol Pathol 26:92-103.

Dion KK, Pak A, Dion KL. (1990). Stereo-typing physical attractiveness: A sociocultural perspective. Journal of Cross-Cultural Psychology 21:378-398.

Feingold A. (1992). Good looking people are not what we think. Psychological Bulletin 111:304-341.

Fukuda Y, Ushinjima K, Kitano T, et al. (1999). An analysis of subjective complaints in a population living in a methylmercury-polluted area. Environ Res 81:100-107.

Grimes P, Davis L.(1991). Cosmetics in blacks. Dermatology Clinique, 9(1), 53-68.
Hardwick N, Van Gelder L, Van der Merwe C, Van der Merwe M.(1989). Exogenous ochronosis: an epidemiological study. British Journal of Dermatology, 120(1), 229-238.

Hall RE. (1992). Bias among African Americans regarding skin color: implications for social work practice. Research on Social Work Practice 2:479-86.

Hall RE. (1998). Skin color bias: A new perspective on an old social problem. The Journal of Psychology 132(2): 238-41.

Harvey A. (1995). The issue of skin color in psychotherapy with African Americans. Families in Society: The Journal of Contemporary Human Services 76 (1):3-8.

Hertel BR, Hughes M. (1990). The significance of skin color remains: a study of life chances, mate selection, and ethnic consciousness among Black Americans. Social Forces 68:1105-1120.

Hill ME. (2000). Color differences in the Socioeconomic Status of African American men: Results of a longitudinal study. Social Forces 78:1437-60.

Hill ME. (2002). Skin color and the perception of attractiveness among African Americans: Does gender make a difference? Social Psychology Quarterly 65(1):77-92.

Hunter ML. (1998). Colorstruck: Skin color stratification in the lives of African American women. Sociological Inquiry 68:517-35.

Karamagi C, Owino E, Katabira ET. (2001). Hydroquinone neuropathy following use of skin bleaching creams: case report. East Afr Med J. 78(4):223-4.

Keith VM, Herring C. (1991). Skin tone and stratification in the Black community. The American Journal of Sociology 97: 760-778.

Lieb J, Hershman D. (1983). Isaac Newton: mercury poisoning or manic depression. Lancet 1983;1479-1480.

Mahe A, Blanc L, Halna J, Keita S, Sanogo T, Bobin P. (1993).[An epidemiologic survey on the cosmetic use of bleaching agents by the women of Bamako. Annales de Dermatologie, 120(12), 870-873. [Article in French]

Mahe A, Keita S, Bobin P.(1994).[Dermatologic complications of the cosmetic use of bleaching agents in Bamako (Mali)]. Ann Dermatol Venereol. 121(2):142-6. [Article in French]

Mahe A, Ly F, Aymard G, Dagou J. (2003).Skin diseases associated with the cosmetic use of bleaching products in women from Dakar, Senegal. British Journal Dermatology,148(3), 493-500.

Mahe A, Ly F, Badiane C, Balde Y, Dangou J.(2002).Irrational use of skin-bleaching products can delay the diagnosis of leprosy. International Journal of Leprosy and Other Mycobacterial Diseases, 70(2), 119-121.

Malangu N, Baloyi H, Ngema Z, Hlophe P. Predictors of topical steroid misuse among patrons of pharmacies in Pretoria (In press).

Mazumdar S. (1989). Racist response to racism: The Aryan myth and South Asians in the US. South Asia Bulletin 9(1):47-55.

Ngim CH, Foo SC, Boey KW, Jeyaratnam J. Chronic neurobehavioral effects of elemental mercury in dentists. Br J Indust Med 1992;49:782-790.

Ohnishi T, Suzuki T, Watanabe S, Takahashi H.(1996). Erythrodermic psoriasis associated with hypericemia and Iatrogenic Cushing's syndrome due to topical corticosteroid therapy. International Journal of Dermatology, 35(5), 379-380.

Pitche P, Afanou A, Amanga Y, Tchangai-Walla K. (1997).[Prevalence of skin disorders associated with the use of bleaching cosmetics by Lomé Women]. Santé,7(3),161-164. [Article in French]

Porter CP. (1991). Social reasons for skin tone preferences of Black School-Age children.American Journal of Orthopsychiatry 61:149-154.

Raynaut E, Cellier C, Perret J.(2001).[Depigmentation for cosmetic purposes: prevalence and side-effects in a female population in Senegal]. Annales de Dermatologie, 128(6-7), 720-724. [Article in French]

Russell K, Midge W, Hall R. (1992). The color cmplex: The politics of Skin color among African Americans New York: Anchor.

Scott C, Melinda M. (2000). The pertuation of subtle prejudice: Race and gender imagery in 1990s television advertising. Sex Roles 42(5/6):363-89.

Sylla R, Diouf A, Niane B, Ndiaye B, Guisse MB, Diop A, Ciss M, Ba D.
Artificial depigmentation practice of the skin in women of Dakar and analytical study of the cosmetic products used] Dakar Med. 1994;39(2):223-6. [Article in French]

Siblerud RL. (1989). The relationship between mercury from dental amalgam and mental health. Am J Psychotherapy 43:575-587.

Wade TJ. (1996). The relationship between Skin color and self-perceived global, physical, and sexual attractiveness, and self-esteem for African Americans. Journal of Black Psychology 22:358-73.

Science in Africa - Africa's First On-Line Science Magazine

Copyright  2002, Science in Africa, Science magazine for Africa CC. All Rights Reserved

Terms and Conditions