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Prioritizing Skin Bleaching as a Public Health Concern

By Ogo Maduewesi 

Skin conditions and diseases continue to be neglected, underestimated, and written off as problems that are not life-threatening. But this leaves the dangers of harmful skin-bleaching treatments—which are ubiquitous in Nigeria, across Africa, and among dark-skinned individuals around the world—largely unrecognized. The World Health Organization published an assessment on skin bleaching in 2011, which stated that 77 percent of Nigerians use skin-lightening products—the highest proportion in the world. Mercury, the active ingredient in most bleaching creams and soaps, is banned in most African nations, including Nigeria, yet these products still find their way into shops and homes across the continent. Given the hazards associated with the use of these products, skin bleaching must be recognized as an urgent public-health concern.

Exposure to chemicals in the bleaching products—notably, mercury, hydroquinone, and steroids—has been associated with a variety of adverse health effects. According to the WHO, the main adverse effect of the inorganic mercury contained in skin lightening soaps and creams is kidney damage, but the chemical may also cause skin rashes, skin discoloration, and scarring, as well as a reduction in the skin’s resistance to bacterial and fungal infections. Other effects include anxiety, depression, psychosis, and peripheral neuropathy. The dangers are particularly acute in Africa as users mix together multiple products in an attempt achieve faster results, including hazardous caustic agents (such as automotive battery acid, washing power, toothpaste, cloth bleaching agents, or lemon) that contain high levels of mercury, increasing the risk of severe health problems.

The negative effects reach beyond those who use the products directly, according to the WHO. When these soaps and creams are used, the mercury they contain enters wastewater. These compounds are then introduced to food chains, and may ultimately be consumed by humans. The WHO points to the particular danger facing pregnant women who consume contaminated fish: When mercury compounds are transferred to a fetus, they can cause neurological problems later in the child’s life.

Why do people use these products despite the dangers? The truth is that most users are ignorant of the damaging effect of the products on their health. Even when they know the risks, there is always someone around to assure them that they’ve been using these substances for years with no issues. Some have just partial information, and might think, say, that a product is healthy as long as it does not contain hydroquinone. The belief that fairer skin is more appealing than darker skin means that people bleach their skin to enhance their beauty; they desire to feel and be perceived as beautiful. It is probably impossible to change people’s desire for fairer skin, and their belief that they become more appealing and successful with fairer skin, but those who use these products are often not even warned of the risks through health education campaigns.

Despite numerous articles written, blogs posted, satires published, and a BBC documentary released on the topic, none proffer active solutions. There have been research papers dating as far back as the 1990s on the dangers of skin bleaching. Hydroquinone was first used in the 30s, but the skin-bleaching industry is booming today, as products are manufactured in and imported from Asia. Many individuals and small businesses are joining this lucrative business, and skin-bleaching products flood Nigerian markets like bottled water. In 2009 report from Global Industry Analysts declared skin-lightening a $10 billion industry; the organization also projects that the number would hit $23 billion by 2020. In Nigeria, the country with has the highest proportion of skin beaching, these products can be found in any cosmetic, street, or beauty shop, and in open markets. They are advertised openly on billboards, television, and social media. Skin whitening is big business across Africa; one skin-whitening product called Whitenicious, which claims to use all natural products, launched by Nigerian-Cameroonian pop musician Reprudencia Sonkey (known by her stage name, Dencia), sold out almost immediately after its release. Within three weeks, sales surpassed 15,000 units.

Extensive public awareness campaigns have been going on for years, led by the WHO, international NGOs, and media outlets, to educate adults on the dangers of smoking, on safe sex, on healthy eating, and on the importance of driving with a seat belt. These efforts have not tried to stop people from having sex, smoking, not exercising, or eating junk, but have focused on providing assistance. All people have a right to health, and skin bleaching must be treated just like other public-health concerns. The fact that a rising number of people are bleaching their skin, destroying their melanin and exposing themselves to health risks, indicates a failure of public-health outreach.

When there is no public education campaign or when such a campaign fails, people are left to look after their health without reliable guidance. In Nigeria, individuals often bear the costs of their own health care, and are often ignorant of the health implications of their personal behavior. People thus turn to self-treatment and self-medication, substandard medications, and whatever chemicals and herbs are readily available. Addressing this problem should be made a priority for the WHO and for ministries of health across Africa and beyond. In addition to the efforts dermatologists are making in educating their patients about dangers of skin bleaching, the entire medical community should follow recommendations to devote its energy to researching and addressing this issue.

The skin-bleaching products flooding Nigerian markets must be actively and thoroughly checked by the National Agency for Food and Drug Administration and Control (NAFDAC), the Standard Organisation of Nigeria (SON), and Nigerian customs officials to ensure that the dangerous ones are not smuggled in—banned should mean banned. All African countries should take strict measures to keep out these products, and safer brands of skin-bleaching products should be offered—and at affordable prizes—in the way free condoms are made available for people to protect themselves during sex. All-natural products containing papaya, lemon juice, or rice water can serve as alternatives, and azelaic acid and niacin amide are claimed to be safer than the compounds often found in bleaching creams and soaps.

My own startup social enterprise, Outer Shell Africa–Skin and Appearance Social Lab, is making a positive difference in the lives of sub-Saharan Africans living with skin conditions and diseases and visible differences. My experience founding and working for more than eight years with Vitiligo Support and Awareness Foundation (VITSAF) inspired Outer Shell Africa. Vitiligo is a long-term condition that causes pale, white patches to develop on the skin—in severe cases these cover the whole body. Vitiligo affects one in every hundred people and can strike anyone at any time, and can lead to depression and social isolation. Working on the Vitiligo cause showed me how neglected and underestimated skin health, visible differences, and psychosocial challenges are in Africa. At Outer Shell Africa, we use digital storytelling and other creative tools to emphasize “social wellness and social inclusion” for people living with these conditions. I do not encourage skin whitening or bleaching; I educate people about the dangers of these practices and work on generating public awareness.

Do we have to wait until more harm is done before we act? A study or a WHO statement may attract readers and researchers, but it does not make much difference on the ground. What we need is a grass-roots campaign with a strong call to action. Dangerous skin-care treatments can be life-threatening, and skin health deserves our urgent attention. All people have a right to health.

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Ogo Maduewesi is an Ashoka fellow/Making More Health fellow, social entrepreneur, and writer. She is passionate about social well-being and the rights of sub-Saharan Africans living with skin conditions and visible differences. Maduewesi is the founder of Vitiligo Support and Awareness Foundation (VITSAF), the first Vitiligo patient-driven organization in sub-Saharan Africa, and she recently spearheaded Vitiligo in Africa Alliance. She is also the founder of Outer Shell Africa–Skin and Appearance Social Lab. 

[Photo courtesy of Adam Jones]

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