Pigment International

REVIEW ARTICLE
Year
: 2021  |  Volume : 8  |  Issue : 1  |  Page : 4--7

The unhealthy obsession with fairness and the menace of fairness creams in India


Arijit Coondoo1, Rashmi Sarkar2,  
1 Department of Dermatology, KPC Medical College, Kolkata, West Bengal, India
2 Department of Dermatology, Lady Hardinge Medical College, New Delhi, India

Correspondence Address:
Arijit Coondoo
Department of Dermatology, KPC Medical College, Canvas, 46/2, Bosepukur Road, Kolkata 700042, West Bengal
India

Abstract

Humanity has been obsessed with the partiality towards fair skin since time immemorial leading to unhealthy practices. The recent manifestation of this obsession is the huge number of fairness creams which has flooded the Indian cosmetic market. Some corticosteroid creams are also used as fairness creams because of the side-effect of hypopigmentation which is mistaken for fairness. Such misuse of topical corticosteroids leads to unwanted physical and psychological side-effects which have been collectively described as “Topical steroid dependent/damaged face” (TSDF). Concerted efforts by professional and social organizations [such as IADVL and Pigmentary Disorders Society (PDS)], politicians and media representatives, to fight this social menace of fairness craze and fairness creams have started yielding some positive results recently.



How to cite this article:
Coondoo A, Sarkar R. The unhealthy obsession with fairness and the menace of fairness creams in India.Pigment Int 2021;8:4-7


How to cite this URL:
Coondoo A, Sarkar R. The unhealthy obsession with fairness and the menace of fairness creams in India. Pigment Int [serial online] 2021 [cited 2021 Aug 2 ];8:4-7
Available from: https://www.pigmentinternational.com/text.asp?2021/8/1/4/313126


Full Text



 INTRODUCTION



Since the early days of civilization, people with fair skin have had an advantage in various walks of life. This obsession with fair skin has led to a craze for fairness among darker skinned individuals leading to efforts to lighten the skin with the help of fairness creams. The cosmetic and pharmaceutical industries have further enhanced this obsession by producing fairness creams. While some creams are marketed to lighten skin color, creams containing topical corticosteroids (TCs) are covertly used for the same purpose taking advantage of the hypopigmentary side effects of these drugs. The use of fairness creams has led to a plethora of psychosocial and medical problems. Efforts to tackle this menace have started but are still ineffective.

 FAIRNESS



Fairness or light skin color is described as the quality of having light-colored skin or fair complexion.[1] Since the early ages of human civilization fairness has been equated with beauty. Colorism, also known as skin color stratification, has been used to describe the prejudice based on skin color prevalent within various races of humanity (however, this does not include the interracial discrimination causing friction between various communities and nations). This prejudice creates a privileged position within individual communities for those who possess a lighter complexion. Colorism has been prevalent across centuries in various regions of the world such as India, Eastern Asia, Africa, Latin America, and USA.[2] The prejudice resulting from colorism has led to the system of “pigmentocracy.” Pigmentocracy is a practice whereby people with lighter skin tones are given more privilege than those with darker skin color.[3] Throughout the world, pigmentocracies have given rise to a social hierarchy, wherein the highest social status has been conferred on lighter skinned persons with the lowest status being allotted to the dark-skinned individuals.[4] Pigmentocracy in India has led to a social hierarchy wherein people of lighter skin have had the advantage of being more educated, more wealthy, and more powerful. Additionally, at various stages in history, India has been invaded and Indians have been overpowered by aliens possessing lighter skin. These social and other factors have led to a general notion of supremacy of fairer skinned individuals over their lighter skinned counterparts.[5] In modern India, this pigmentocracy has led to a fairness craze.[6]

 FAIRNESS CRAZE



The fascination with fairness of skin in India has been prevalent since time immemorial. However, in modern times this obsession has turned into a fairness craze emanating from a mistaken notion that fairness of skin results in an increased advantage in social circles, matrimonial market, and professional fields.[7] Advertisements in the print, audiovisual, electronic, and social media depicting individuals with lighter skin to be at an advantage over others has further fanned this craze. The fair complexioned people have been portrayed as the beautiful people who are more marriageable, confident, and professionally successful.[4] The cosmetic industry, realizing a vast business opportunity, has milked this obsession by marketing skin lightening creams popularly known as fairness creams.[8]

 MENACE OF FAIRNESS CREAMS



The business of fairness creams started with the marketing of Afghan Snow the first face cream in India in 1919.[9] In the modern era, the first fairness cream was marketed in 1975.[10] The market for fairness creams for women is rising at the rate of 18% and at the rate of 6% to 8% for men every year. By the year 2023 the market is expected to reach Rs 5000 crores.[11] This huge expansion of the market is principally due to a number of reasons, such as (a) the fairness craze epidemic, (b) the cosmetic industry which exploits this craze to market a host of skin lightening products, (c) the marketing of these creams as cosmetics rather than drugs, and (d) clever advertisements with endorsements by celebrities.[6] According to the World Health Organization (WHO), a drug is defined as “any substance or product that is intended to be used to modify physiological systems or pathological states for the benefit of the system.”[12] Fairness creams contain a number of chemicals such as stearic acid, palmitic acid, glycerin, phenol, cetyl alcohol, etc. These chemicals may decrease melanin synthesis or may interfere with the transfer of melanosomes from melanocytes to keratinocytes.[8] Hence, by definition, cosmetics are drugs. However, they are marketed freely without any evidence-based data and are registered with the Central Drugs Standard Control Organization as cosmetics.[13] Additionally, the constituents may produce a large number of dermatological (allergic contact dermatitis, contact leukoderma, exogenous ochronosis) and systemic side effects.[14] Facial creams also contain nanosized reduced graphene oxide which may excite oxygen in air to produce superoxide anion on exposure to sunlight. The superoxide anion damages living cells, resulting in mutation of facial skin. Hence, fairness creams are liable to be carcinogenic in nature.[15] Advertisements of fairness creams are not controlled by the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954. Hence, without the control of any regulatory body fairness creams can be freely advertised thus fanning the fairness craze further.[14] These advertisements are endorsed by celebrities (usually film stars) with a huge fan following. The fans following these celebrities believe their endorsement and use these products blindly.[6] However, recently the Advertising Standards Council of India (ASCI) issued certain guidelines for celebrities endorsing skin lightening products recommending restrictions on portraying any discrimination due to skin color.[16] The problem of fairness creams and their advertisement gets more complicated when a TC containing cream is advertised as a skin lightening by a pharmaceutical company as happened in 2015.[17]

 ABUSE OF TCs AS FAIRNESS CREAMS



The misuse of topical steroids as cosmetic creams was first reported from India in 2006.[18] The skin of the face is very thin resulting in increased permeability of creams. This is particularly true about TCs; the higher the potency the more is the permeability.[6] TC application on the face can result in a number of side effects including hypopigmentation which may occur quite rapidly. This iatrogenic hypopigmentation is often misunderstood as fairness by the laymen. Among other reasons for such misuse is the urge to obtain instant fairness.[19] Kligman et al. in 1975 advocated the use of a combination of hydroquinone, tretinoin, and dexamethasone for the treatment of hypermelanosis.[20] The higher the potency of TC the more was the hypopigmentation.[6] This observation led the pharmaceutical industry to introduce creams containing TC of higher potency which were marketed as “modified Kligman regimen.”[21] In India, unrestricted production, promotion, sale, and long-term use of the various triple combination creams containing TC of various potencies has resulted in a large number of side effects which may negate the cosmetic benefits that may result from such usage. It also results in addiction to the drug.[22] Such a physical and psychological dependence on the drug, collectively described as an entity called “topical steroid damaged/dependant face (TSDF)” which may be the ultimate result of misuse of TC as fairness cream.[23]

 TACKLING THE MENACE



The menace of fairness craze fanned by fairness cream advertisements has encompassed Indian society in its tentacles for a prolonged period. However, recently some signs of a fightback by social activists and celebrities have raised hopes of a fightback. “Dark is beautiful” is a social awareness campaign launched in 2009 by Kavitha Emmanuel, founder of “Women of Worth” to draw attention to the injustice meted out socially to dark colored individuals due to the bias for fair skin ingrained in the fabrics of Indian society.[24] Alert doctors and social activists have joined hands to form action forums and taskforces such as the IADVL taskforce against topical steroid abuse (ITATSA) for effective and organized campaigns against the use of topical steroids as fairness creams.[6] Though there are no regulations against the advertisement and marketing of fairness creams, the Advertisement Standards Council of India (ASCI) has recently recommended that advertisement of fairness creams should not send a wrong message based on skin color showing people with darker skin as inferior to fair skinned persons. Such advertisements should not make them unhappy or depressed or portray them to be at a disadvantage in the various aspects of life including marriage, job placement, promotions, etc.[25] Celebrity endorsements misleading their fans to believe in the capability of fairness creams to improve the quality of skin and life of individuals are one of the main causes of the fairness craze. Recently, the Consumer Protection Bill, 2019 seeks to penalize misleading advertisements placed on virtually any medium, including television, radio, print, outdoor advertisement, e-commerce, direct selling, and telemarketing.[26] Another hopeful sign is the recent spate of celebrities refusing to endorse fairness creams as well as countercampaigns by celebrities.[27],[28] Another ray of hope, though faint, for the campaign against fairness creams, has been kindled by some demands raised in Parliament by a lone Member of Parliament (MP) in 2016.[29]

 CONCLUSION



The fairness craze is a social menace which threatens to rip the fabric of Indian society. Fairness cream advertisements which promise lighter skin tone deceive and demean people and fan the fairness craze. Such fairness creams and their advertisements lead to a feeling of inadequacy in the minds of darker skinned individuals. Endorsements of fairness creams by celebrities mislead their fans and need to be stopped forthwith.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Definition of Fairness in English. [Online]. Oxford Dictionary website. Available at: en.oxforddictionaries.com/definition/fairness. Accessed January 8, 2020.
2Franklin I. Living in a Barbie world: skin bleaching and the preference for fair skin in India, Nigeria, and Thailand. [Online]. Available at: https://pdfs.semanticscholar.org/dfb4/73b466754d9535d76ab872d8242f495ec77f.pdf. Accessed January 8, 2020.
3Harris T. Pigmentocracy. [Online] Freedom’s Story, TeacherServe. National Humanities Center website. Available at: nationalhumanitiescenter.org/tserve/freedom/ 1865 -1917/essays/pigmentocracy.htm. Accessed January 8, 2020.
4Thappa DM, Malathi M. Skin colour matters in India. Pigment Int 2014;1:2-4.
5Ladizinski B, Mistry N, Kundu RV. Widespread use of toxic skin lightening compounds: medical and psychosocial aspects. Dermatol Clin 2011;29:111-23.
6Lahiri K, Coondoo A. Abuse of topical corticosteroids and the menace of fairness creams. In: Venkataram M, ed. ACS(I) Textbook on Cutaneous and Aesthetic Surgery. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2017. pp. 1396-406.
7Verma SB. Obsession with light skin: shedding somelight on use of skin lightening products in India. Int J Dermatol 2010;49:464-5.
8Agarwal M, Roy V. Fairness creams in the Indian market: issues to be resolved. Indian J Clin Pract 2012;22:45-8.
9Our Heritage. Available at: https://www.petalsesp.com/about/heritage.aspx. Accessed January 8, 2020.
10Wikipedia. Fair and Lovely (Cosmetics). [Online]. Wikipedia website. Available at: en.wikipedia.org/wiki/Fair_%26_Lovely. Accessed January 8, 2020.
11India fairness cream & bleach market overview 2018-2023–ResearchAndMarkets.com. Available at: https://www.businesswire.com/news/home/20180321005573/en/India-Fairness-Cream-Bleach-Market-Overview-2018-2023. Accessed January 8, 2020.
12WHO. Drugs. Available at: https://www.who.int/substance_abuse/publications/drugs/en/. Accessed January 9, 2020.
13Central Drugs Standard Control Organization. Available at: https://morulaa.com/registration-services-in-india-cdsco/. Accessed January 9, 2020.
14Jose A, Ray JG. Toxic content of certain commercially available fairness creams in Indian market. Available at: https://www., cogentoa., com/article/10.1080/2331205X.2018. 1433104. Accessed January 9, 2020.
15Maity S, Pakhira B, Ghosh S et al. Microcarbon-based facial creams activate aerial oxygen under light to reactive oxygen species damaging cell. Appl Nanosci 2017;7:607-16. Available at: https://doi.org/10.1007/s13204-017-0604-9. Accessed January 9, 2020.
16Advertising Standards Council clamps down on fairness products. Available at: https://www.thehindubusinessline.com/companies/Advertising-Standards-Council-clamps-down-on-fairness-products/article 2084 7082.ece. Accessed January 10, 2020.
17Debroy S. Drug company faces heat over fairness cream. [Online] The Times of India website. Available at: timesofindia.indiatimes.com/city/mumbai/Drug-company-faces-heat-over-fairness-cream/articleshow/ 4864 4671.cms. Accessed January 10, 2020.
18Rathi S. Abuse of topical steroid as cosmetic cream: a social background of steroid dermatitis. Indian J Dermatol 2006;51:154-5.
19Coondoo A. Topical corticosteroid misuse: the Indian scenario. Indian J Dermatol 2014;59:451-5.
20Kligman AM, Willis I. A new formula for depigmenting human skin. Arch Dermatol 1975;111:40-8.
21Majid I. Mometasone-based triple combination therapy in melasma: is it really safe? Indian J Dermatol 2010;55:359-62.
22Ghosh A, Sengupta S, Coondoo A, Jana AK. Topical corticosteroid addiction and phobia. Indian J Dermatol 2014;59:465-8.
23Lahiri K, Coondoo A. Topical steroid damaged/dependent face (TSDF): an entity of cutaneous pharmacodependence. Indian J Dermatol 2016;61:265-72.
24Dark is beautiful: the battle to end the world’s obsession with lighter skin. Available at: https://www.theguardian.com/inequality/ 2017 /sep/04/dark-is-beautiful-battle-to-end-worlds-obsession-with-lighter-skin. Accessed January 11, 2020.
25ASCI releases guidelines for advertising of fairness products. Available at: https://economictimes.indiatimes.com/industry/services/advertising/asci-releases-guidelines-for-advertising-of-fairness-products/articleshow/ 4040 5288.cms. Accessed January 8, 2020.
26Misleading advertisements may land celebrity endorsers in jail. Available at: https://www.livemint.com/companies/news/misleading-advertisements-may-land-celebrity-endorsers-in-jail- 1564 489968693.html. Accessed January 11, 2020.
27Bollywood stars who refused to endorse fairness creams. Available at: https://timesofindia.indiatimes.com/entertainment/hindi/bollywood/photo-features/bollywood-stars-who-refused-to-endorse-fairness-creams/photostory/ 5816 1094.cms. Accessed January 8, 2020.
28Unfair & ugly: Abhay Deol slams Bollywood endorsements for fairness products. Available at: https://yourstory.com/2017/04/abhay-deol-bollywood-endorsements. Accessed January 12, 2020.
29Demand to ban advertisements on fairness creams in Rajya Sabha. Available at: https://m.economictimes.com/news/politics-and-nation/demand-to-ban-advertisements-on-fairness-creams-in-rajya-sabha/articleshow/ 5339 5126.cms. Accessed January 12, 2020.