The Complexion Conundrum

 The Complexion Conundrum is the scribed dialogue between me and Style.comarabia’s senior editor Sofia Guellaty, exploring the controversial skin lightening trend in the Middle East.

You can read the Style.comarabia's fnal version here: Let's Be Fair

What do they say? Grass is always greener on the other side of the pond. People in the West are baking their bodies under the sun to attain a bronzed/tanned complexion even at the risk of getting skin cancer. Meanwhile, people on our side of the pond (Middle East) are looking for skin lightening solutions to ditch their perfect caramel/chocolate complexions in favor of a pale ghost-white complexion – idiosyncrasies of human nature go figure.

Skin Whitening

Let me start by clarifying one thing, the term skin whitening is misleading, I prefer to address complexion blending as skin lightening or depigmenting.

You can lighten your skin tone (a shade or two) by getting rid of tan acquired through careless or planned sun exposures, and you can also blend dark patches on your skin (due to hormones, acne or other skin predispositions) to attain a more uniform complexion, but you can’t whiten your skin, at least not without causing serious damage to your skin’s vital structures.

Skin Lightening Treatments

Skin lightening products - also known as bleaching creams, whiteners, skin brighteners, or fade creams - work by reducing a pigment called melanin in the skin. Most people who use lighteners do so to treat skin problems such as age spots, acne scars, or discoloration related to hormones. It is also a technique used to lighten naturally dark skin.

Understanding Skin Color

Skin color is determined by the amount of melanin in the skin. Melanin is a pigment produced by specialized cells called melanocytes. People with dark skin have more melanin.

How much melanin your skin has is mainly a matter of your genetic makeup. Sunlight exposure, hormones, skin damage, and exposure to certain chemicals can also affect melanin production.

Changes in skin color often resolve themselves. For instance, tans fade when the amount of direct exposure to sunlight is reduced. But over time, certain discolorations, such as "age" spots or "liver" spots, become more or less permanent.

What Is Skin Bleaching?

Skin bleaching is a cosmetic treatment to reduce the prominence of skin discolorations and even out the color of the skin. You can buy bleaching creams over the counter or by prescription through a dermatologist.

How Do Skin Lighteners Work?

Skin lighteners contain an active ingredient or a combination of ingredients that reduces the amount of melanin production in the skin where it is applied.

The most widely used ingredient in skin lighteners sold around the world used to be hydroquinone. Recently it has been banned in Europe because of its serious side effects over long-term usage. In U.S. the FDA regulates the use of hydroquinone (over-the-counter skin lighteners can contain up to 2% hydroquinone. Dermatologists can write prescription for lighteners that contain up to 4-6% hydroquinone). In Middle East its use is still uncontrolled and different percentages are available through over the counter sales.

Other skin lighteners use drugs such as steroids and retinoic acid (vitamin A) as active ingredients.

Newer and safer skin lighteners use natural ingredients such as ascorbic acid (vitamin C), kojic acid (a compound that comes from a specific type of fungus) and arbutin (a compound found in various plants).

Answers To Style.comarabia’s Ms. Sofia Guellaty’s Questions:

Is quest for fair complexion a post-colonial trend?

Margaret Hunter an expert on skin of color issues explains the desire to be lighter complexioned quiet eloquently for me. According to her, colorism is the process of discrimination that privileges light-skinned people of color over their dark skin counterparts (This definition of colorism places the phenomenon solely among non-Whites, but colorism also occurs among Whites, but that is another discussion for yet another day :).

The contemporary colorism has its roots in the European colonization of Africa, Asia-Pacific, the Middle East, and the Americas. The complexion consensus empowers light-skinned people with more opportunities, status, and prestige in nearly all these societies. Thus, the values and norms of the complexion consensus influence many people to bleach their skin.

Furthermore, in the Middle East fair people, especially women, are considered prettier and most men prefer to marry a fair woman. In a culture where status and wealth is typically acquired through marriage, physical beauty and complexion translate into a fast track ticket to a life of privilege. This creates a much desired and easy connection between a girl’s social problems and the tone of her skin, explaining the particular prevalence of skin bleaching desire in young females belonging to the middle classes.

Why does Chanel only sell skin lightening products in Asia and Middle-East etc.

Beauty trends and unique regional market demands are the driving forces behind product sales. To run a successful business companies hone in and focus on those criteria.

In Asia like the Middle-East lighter skin tones are considered desirable and affiliated with high status symbol. A huge number of men and women use skin brighteners on regular basis as part of their daily skincare routine. Hence, both these regions are big markets for skin lightening products.

US is a melting pot of ethnicities, there’s an enormous demand for skin brighteners among ethnic communities in US too.

In Europe only people with uneven skin tone are interested in skin lightening products which doesn’t translate into big numbers, hence companies don’t find it a lucrative business strategy to focus on skin bleaching products. As per demand cosmetic companies focus more on tanners and bronzer in those markets.

Do you see a lot of patients that want to whiten their skin?

Of course I do and by Rolls-and-Bentley-loads if I may say so. Arab and Middle Eastern skin is more prone to pigmentation disorders. Actually the skin classification has been revised over time and “Pigmented” is the latest addition to Skin Type Charts. It pertains to skin types; which produces abnormal levels of melanin in response to friction, sun, hormones and inflammation or injuries resulting in uneven complexion.

Most of my patients come to me with complaints of hormone and sun related pigmentation problems in addition to a unique complaint of dark elbows and knees very indigenous to Middle East and Indian Subcontinent.  Najadi Boys know about this pigmentation Achilles heel and tease girls on the subject all the time. I believe dark knees and elbows haunting females are even part of folklore tales originating from the Middle Eastern region.

Where do they (patients) come from?

As I practice in Saudi Arabia, most of my patients seeking skin-lightening treatments are Saudis, some hail from the neighboring Arab Middle Eastern and African countries too.

What is their motivation?

Every region has its indigenous beauty icons. In Middle East mostly the Lebanese, Syrian or Egyptian (music or T.V) celebs are given goddess of beauty and attraction status. As, most of these celebs set high on the glamour pedestal are light skinned, all our girls next door want to bleach their hides to match their silver screen diva’s skin color.

I also believe that the growing preference for white skin is not merely one of choice or aesthetics, but it seems to grow also from self-doubt and the lingering confusions of identity and acceptance. Spousal pressure and acceptance are also quoted as the main reasons by some of my patients seeking skin-lightening treatments.

What are the risks of whitening?

When our skin is exposed to the sun, cells called melanocytes produce pigment to make a shield around the nucleus of the cells to protect it from carcinogenic mutations caused by the UVA & UVB rays. This pigment acts as a barrier shield protecting our skin from cancer and photo-aging.

Long-term use of skin lightening products can increase the risk of skin cancer with sun exposure.

As with any new product, skin lightening products do come with some risks. It’s important to read the label and know the facts before you buy and apply a skin lightener.

Various bleaching agents, including natural ingredients, can cause skin irritation or skin allergies e.g AHA’s (alpha hydroxy acids), high concentration of ascorbic acid (vit. C), tretinoin (vitamin A) etc.

Mercury Warning: Some people apply skin lightener to their entire body to change their complexion, and this can be very risky. Regional ministry of health’s have reported the active ingredient in some skin lighteners (originating from Africa and Asia) can be mercury, using these products can lead to mercury poisoning.

Mercury is a toxic agent that can cause serious psychiatric, neurological, and kidney problems. Pregnant women who use a skin lightener with mercury can pass the mercury to their unborn child.

The use of mercury as an ingredient in skin lighteners is banned in Saudi Arabia, UAE, U.S and Europe. However, some skin lighteners produced outside these regions may still contain mercury.

I always warn my patients to make sure there is no mercury in the skin lightening products they use. Mercury is sometimes listed under other names, such as calomel, mercuric, mercurous, or mercurio.

Steroid Warning: Some skin lighteners contain steroids. Using steroid laced products can lead to increase risk for skin infections, skin thinning, acne, and poor wound healing.

Applying steroids to large areas of skin can put you at risk for health problems related to steroid being absorbed by the body.

Hydroquinone Warning: Long term use of Hydroquinone has been linked with unwanted and untreatable skin discoloration called ochronosis.

Is whitening more dangerous than tanning?

I don’t think whitening is more dangerous than tanning if tried under proper medical guidance. Over the years tanning has been clearly linked with skin cancer.  Dermatologists world around are busy rallying and campaigning to warn against and stop the skin tanning trends.

Skin color (melanin) acts as a shield against skin cancer that’s why we don’t see too many reported cases of cancer in darker skin types. Lighter skin is more prone to getting skin cancer and anybody using skin-lightening creams must remember that by loosing skin color they are loosing their protection shield against harmful UVA and UVB rays. Hence, they must use sunscreen diligently and religiously.

Which products do you recommend? 

I don’t advocate mindless skin bleaching. I usually tell my patients no matter what your skin color it’s the quality and health of your skin that makes you look beautiful. In my opinion a little color in the skin actually adds to a person’s attractiveness.

Product choice-wise, I prefer products that are hydroquinone or cortisone free.

I recommend products containing vitamin C, niacinamide, arbutin, licorice extract, kojic acid, tretinoin, and azelaic acid.

I also strongly advocate use of sunscreen on daily basis, even on cloudy days.

Could you share some whitening stories with us? 

When I moved to Saudi back in 2004 I used to get like 5-10 patients walking in specifically with skin bleaching/whitening requests on daily basis. They were always looking for a miracle cure to change their skin color completely. “Doctor do you have any pills or injections that can change my skin color permanently”, was the most common question rolling off of every patient’s tongue.

When I explained to them it is practically impossible to change your skin color completely without seriously damaging your skin, as complexion is a genetically determined trait. “How did Michael Jackson magically changed his skin color permanently” was the counter query thrown at me. I had to explain over and over again - There is a disease called Vitiligo in which some parts of the skin lose their color producing cells (melanocytes). Michael Jackson had Vitiligo and he opted to destroy all his pigment producing cells to blend his dark skin with the diseased colorless patches and that’s how he became the poster child for skin whitening. During his last days he was seen using face-mask, umbrella and gloves on regular basis because his doctors warned him he was at serious risk of getting skin cancer.

With years of education, constant reiteration and advice most people now understand that skin color is a genetic trait and can’t be tampered with without serious consequences. Now a days I am mostly seeing people with complaints of melasma, dark patches post acne, dark elbows and knees coming over for complexion blending, which I am happy to cater to.

Photo Credits: Sølve Sundsbø & Lily Cole