Psychosocial aspects and implications of the use of skin lightening agents

The quest to be fair is not a concept of the new world. For centuries untold, having a lighter skin tone has been considered as a trait of beauty and supremacy. Society implicates fairness as a factor for getting a prospective life partner. Media portrays fair skin tone as a predecessor for success. These subtle influences affect young minds and drive them towards wanting fair skin. Physicians observe that it is one of the most common forms of body dysmorphic disorder. This article aims to highlight the psychosocial factors that mold this mentality and the possible ill effects it can have on a person, both psychologically as well as physically

1.1 Prevalence of skin bleaching

The use of skin lightening agents has been reported from all across the globe, with the prevalence being highest in Africa and Asia. This may be due to various reasons like the ingrained notion of fair skin associated with beauty, cultural perception and influence of media. In a meta-analysis that was conducted, the life time prevalence of the practice of skin bleaching was estimated to be 27.7%.^5, 6

Skin bleaching was found to be more common in women (43.8%) than in men (35.2%), and in younger age group that is, <30 years (56.9%) compared to 25.9% in age group of 30 to 49 years and 6.1% in those aged >60 years. It was more common among urban population (74.9%) than rural (20.5%). The most commonly abused bleaching agent was found to be topical corticosteroids (73.5%) followed by hydroquinone (53.2%), mercury (34.4%) and a combination of other chemicals (54%).⁵

Treatment methods employed by patients

Skin lightening agents range from injections, tablets and the most frequently abused agent-topicals. A wide range of topical skin lightening agents are available, which may be either synthetically prepared or natural derivatives. Most of the topicals contain a combination of various bleaching agents.

Depending on their mechanism of action, skin lightening agents may be classified into the following groups (Table 1).⁸TABLE 1. Classification of skin lightening agents⁸