Lighter skin color is highly valued and desired by people in several regions of the world, including Asian, African, and Caribbean countries.1 While the reasons for this trend are complex, they are rooted in Eurocentric beauty standards from histories of slavery, colonialism, and colorism. Despite progress toward representation and equity, lighter skin is still often associated with higher socioeconomic background, wealth, status, and beauty.1 In the wake of increasing concerns over the safety and long-term consequences for consumers, companies have continued to market and sell whitening products.2 Some contain toxic ingredients like mercury while others use hydroquinone, which can cause significant adverse effects if not used under the supervision of a physician.2 In this study, we analyzed global online search interest in skin whitening using Google Trends.3
Data from October 2022 to October 2023 were assessed using search terms “skin whitening,” “skin lightening,” and “skin bleaching.” Google Trends 0 to 100 point system was used, where 100 indicates peak popularity and 50 means the term was half as popular.3 Search term popularity is relative to the total number of searches in that location during the chosen timeframe.3 Worldwide search history was included, while low search volume regions were excluded.
The term “skin whitening” was found to be the most popular in South Asian and West African countries (Figure 1a). The top five countries included Pakistan (100), Nigeria (74), Ghana (71), Sri Lanka (67), and India (56). “Skin lightening” searches were most common in African countries (Figure 1b), with the greatest popularity coming from Nigeria (100), Zimbabwe (98), Zambia (77), Uganda (77), and Ghana (73). “Skin bleaching” was most commonly searched in Caribbean and African countries (Figure 1c) such as St. Vincent and Grenadines (100), Jamaica (78), Ghana (54), Nigeria (53), and Zimbabwe (36). Nigeria and Ghana were present in the top five for all three search categories, and Zimbabwe was present in two out of three. The top related queries for all three categories were about skin products and creams.
Figure 1.
Global search trends for the terms (a) “skin whitening,” (b) “skin lightening,” and (c) “skin bleaching”.
The global market for skin whitening was estimated to be $8.8 billion USD in 2022.4 It is projected to continue growing to reach $15.7 billion by 2030.4 The target consumers for this sector include women of color, who account for approximately 80% of worldwide sales.2 These products are particularly popular in regions where fair skin and Eurocentric beauty ideals are culturally valued such as Africa, Asia-Pacific, the Middle East, and the Caribbean.1,2,5 Online search trends from Google Trends reflect these patterns for all three keywords used, with the highest popularity seen in Pakistan, Nigeria, and St. Vincent and Grenadines, respectively. Variances were present among countries with grossly similar social landscapes such as Canada and the US, and this may reflect differences in immigration patterns and ethnic diversity. In many of these communities, skin color is a contributing factor in socioeconomic status, employment, and marriageability.1,2,5 This creates increasing demand for skin whitening cosmetics and fuels both legal and illegal sale of products.5,6
While Google Trends is beneficial for understanding online search patterns, there are limitations with its use. Regions with low search volume are excluded, and areas with limited or decreased Internet access may not be accurately represented. Additionally, use of varying search terms and phrases in different regions may impact the accuracy of the study’s findings.
Along with perpetuating dangerous patterns of colorism, skin whitening products also may contain agents whose unsupervised use can result in multiple short- and long-term complications.2 Despite international efforts to regulate the industry (including countries like Gabon, Jamaica, and Sri Lanka banning use of mercury in lightening products), unsafe formulations persist.7 Table 1 shows the concentrations of mercury and hydroquinone found in skin whitening products tested by the US Food and Drug Administration (FDA).8
Table 1.
US Food and Drug Administration–reported skin products found to contain mercury and hydroquinone
| Products |
Year
tested |
Country
of origin |
Mercury content
(parts per million) |
Hydroquinone
content (%) |
|---|---|---|---|---|
| CCM Special Cream Turmeric | 2022 | – | 8088 | – |
| CCM Perfect 365 White Cream | 2022 | – | 4322 | – |
| Be Be Special Cream CCM/Yellow | 2022 | – | 8909 | – |
| Be Be Special Cream | 2022 | – | 3110 | – |
| La Tia Mana Crema Limpiadora y Curativa | 2022 | Mexico | 5432 | – |
| Ling Zhi BB Whitening Cream | 2022 | Japan | 1393 | – |
| Skin Care & Cosmetic MSII Whitening Peeling | 2022 | France | 1581 | – |
| Skin Care & Cosmetic MSII Express Peeling | 2022 | France | 5797 | – |
| Collagen Plus – Vit E Cream, Night Cream | 2022 | – | 3670 | 2.0% |
| Aneeza Gold Beauty Face Cream | 2022 | Pakistan | 12,400 | – |
| HIYADY Glutatione Cream White & Bright | 2022 | – | 15,900 | – |
| Light & Natural CAROTONE Black Spot Corrector CRÈME B.S.C. | 2022 | Côte d‘Ivoire | – | 4.4% |
| African Queen Strong Bleaching Treatment | 2022 | United States | – | 3.6% |
| Amos Make Me White in 7 Days | 2022 | United States | – | 1.2% |
| B.B. Clear Dark Spot Remover Cream | 2022 | Togo | – | 4.4% |
| Kim Whitening Pearl and Snowlotus Cream | 2019 | – | 47 | – |
| Golden Pearl Beauty Cream | 2019 | – | 12,000 | – |
| Chandni Whitening Cream | 2019 | Pakistan | 8790 | – |
| Goree Beauty Cream | 2019 | – | 17,200 | – |
| Sandal Whitening Beauty Cream | 2019 | Pakistan | 13,100 | – |
| Monespa Express Peeling | 2019 | – | 5030 | – |
| Face Fresh Beauty Cream | 2019 | – | 18,500 | – |
The FDA strictly limits the use of mercury in cosmetic products to <1 part per million (ppm), but skin whitening topicals that are frequently manufactured abroad and sold illegally in the US are still found to contain undisclosed and unregulated amounts of mercury.9–11 For example, the cosmetics company Goree stated that its products strictly comply with the recommended 1 ppm threshold for mercury in skin whitening creams.12 However, FDA testing has found their product to contain 17,200 ppm of mercury, with other independent testing organizations finding levels up to 21,699 ppm.12 Adverse reactions to mercury exposure include contact dermatitis, hyperpigmentation, nail discoloration, malar rash, and erythema.8 Mercury toxicity can also cause permanent neurologic damage in users and immediate family members through spread of vapors.11
Hydroquinone is another common ingredient used in whitening products. In 2006, concerns regarding carcinogenicity and adverse reactions led the FDA to propose a ban on the agent in over-the-counter formulations.13 When used appropriately and under the supervision of a physician, the risk for complications is low. However, its presence in skin whitening products remains concerning because unmonitored use of hydroquinone can also result in abnormal skin pigmentation, cataracts, milia, scleral and nail pigmentation, darker pigmentation of skin overlying finger and toe joints, and trimethylaminuria.14
With increasing globalization, it is important to understand cultural practices to best educate patients on skin safety. Clinicians and end-users should also be aware that ingredient lists provided with skin-lightening agents are not always accurate or comprehensive. Awareness of skin whitening trends can promote transparency, enable culturally competent conversations about the health hazards of skin whitening products, and promote effective care for patients of all backgrounds.
—Neha Arora, MBA
School of Medicine, Texas A&M University, Dallas, TX, USA
narora2018@tamu.edu
—Sanober Amin, MD, PhD
Dermatology Solutions, Grapevine, TX, USA
References
- 1.Sommerlad M. Skin lightening: causes and complications. Clin Exp Dermatol. 2022;47(2):264–270. doi: 10.1111/ced.14972. [DOI] [PubMed] [Google Scholar]
- 2.Pollock S, Taylor S, Oyerinde O, et al. The dark side of skin lightening: an international collaboration and review of a public health issue affecting dermatology. Int J Womens Dermatol. 2020;7(2):158–164. doi: 10.1016/j.ijwd.2020.09.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Google Trends . Accessed December 13, 2023. https://trends.google.com/trends/explore?date=2022-10-01%202023-10-01&q=skin%20lightening.
- 4.Skin Lighteners—Market Study by Global Industry Analysts, Inc. www.strategyr.com. https://www.strategyr.com/market-report-skin-lighteners-forecasts-global-industry-analysts-inc.asp.
- 5.Liu Y, Spitz KE, Nguyen HP.. Skin lightening practices, awareness of social drivers, and the role of regulation in between. J Am Acad Dermatol. 2021;85(6):e415–e416. doi: 10.1016/j.jaad.2021.08.027. [DOI] [PubMed] [Google Scholar]
- 6.Desai SR, Khanna R.. The skin bleaching epidemic: Reply to “Regulation of skin lightening agents in the United States and implications for public health.” J Am Acad Dermatol. 2021;85(6):e413. doi: 10.1016/j.jaad.2021.05.076. [DOI] [PubMed] [Google Scholar]
- 7.WHO . Countries unite to remove mercury from hazardous skin lightening products. February 14, 2023. https://www.who.int/news/item/14-02-2023-countries-unite-to-remove-mercury-from-hazardous-skin-lightening-products.
- 8.US FDA . Skin Products Containing Mercury and/or Hydroquinone. February 2, 2023. https://www.fda.gov/consumers/health-fraud-scams/skin-products-containing-mercury-andor-hydroquinone.
- 9.Hamann CR, Boonchai W, Wen L, et al. Spectrometric analysis of mercury content in 549 skin-lightening products: is mercury toxicity a hidden global health hazard? J Am Acad Dermatol. 2014;70(2):281–287.e3. doi: 10.1016/j.jaad.2013.09.050. [DOI] [PubMed] [Google Scholar]
- 10.US FDA . CFR—Code of Federal Regulations Title 21, Subchapter G—Cosmetics. Food and Drug Administration, Department of Health and Human Services; 2023.
- 11.US FDA . Mercury Poisoning Linked to Skin Products. February 9, 2019. https://www.fda.gov/consumers/consumer-updates/mercury-poisoning-linked-skin-products.
- 12.Senthilingam M. Skin whitening creams containing high levels of mercury continue to be sold on the world’s biggest e-commerce sites, new report finds. CNN. Accessed February 28, 2024. https://www.cnn.com/2022/03/09/world/zmwg-skin-whitening-creams-mercury-ecommerce-sites-intl-cmd/index.html.
- 13.Levitt J. The safety of hydroquinone: a dermatologist’s response to the 2006 Federal Register. J Am Acad Dermatol. 2007;57(5):854–872. doi: 10.1016/j.jaad.2007.02.020. [DOI] [PubMed] [Google Scholar]
- 14.Olumide YM, Akinkugbe AO, Altraide D, et al. Complications of chronic use of skin lightening cosmetics. Int J Dermatol. 2008;47(4):344–353. doi: 10.1111/j.1365-4632.2008.02719. [DOI] [PubMed] [Google Scholar]