The commercial opens with a close-up on the face of a dusky-complexioned girl. She is sad and gloomy. The reason, we are told in a few frames, is because she was unable to land a dream job due to her dark skin. Her best friend suggests a solution: use a popular skin-whitening cream and, hey presto, a couple of weeks later, she is several shades fairer, glowing... and smiling broadly because she has bagged the much-coveted job.

Beautiful, fair and successful - these are just some of the underlying promises made by the increasing number of skin-whitening cream manufacturers in ads that attempt to lure those with dusky complexions to become lighter skinned.

The implication is that by using their product and improving your skin's complexion - which essentially translates to making it whiter - you will get that job, a promotion at work, a great marriage proposal and, on the whole, lead a happier life.

If people in the West are obsessed with acquiring a tan, for which they are willing to spend hours slathered with suntan lotion, sizzling under sun beds and risking skin cancer, in several countries in the East including India, Pakistan and the Philippines, people with a natural tan can't get enough of creams that promise a fairer skin.

According to a report in the Financial Times, the skin-whitening cream market in India is booming, with multinational and local companies raking in more than Rs20.5 billion (Dh1.45 billion) a year.

The global market for such bleaches and creams is projected to reach $10 billion by 2015, according to a report by Global Industry Analysts (GIA) .

In the rush to become fair, what a lot of consumers don't know is that many of the products contain harmful ingredients that could leave them with conditions ranging from eczema to a life-threatening health problem. 

Danger in a jar

In a Gulf News report earlier this month, Health Authority Abu Dhabi (Haad), which regulates the Abu Dhabi healthcare sector, warned the public against the use of some skin-whitening products which contain mercury.

Continuous use of products that contain mercury could lead to mercury poisoning, which doesn't just harm the person using the cream but, in the case of pregnant women, the foetus, say experts. Some of the symptoms of mercury poisoning can be minor, such as sore mouth and gums, tiredness, fatigue and memory loss, but it can also lead to kidney problems and damage to the nervous system.

Haad has urged the public to stop using any whitening product that may contain the words mercurouschloride, calomel, mercuric, mercurio or mercury, the report added.

However, despite warnings from experts and several reports highlighting the dangers of using products that contain harmful ingredients, the demand doesn't seem to be lessening thanks to aggressive ad campaigns. 

Star power

In India, Bollywood stars may not be using these creams but several, including Shah Rukh Khan, John Abraham, Sonam Kapoor and Katrina Kaif, are raking in mega bucks endorsing products that promise to make men and women fairer.

And celebrities themselves are not immune to the lure of skin-lightening. According to US police records, skin-whitening creams were among the items found in Michael Jackson's home after his death in June 2009, even though he denied bleaching his skin.

Predictably, this trend has raised the hackles of people in several quarters, with politicians and women's groups lashing out against adverts of creams that promote fair skin.

Brinda Karat, a prominent MP in India, branded such ads "objectionable". She has made formal complaints about the advertisements to Indian authorities adding that they exacerbate a social stigma - that darker skin historically meant lower-class castes - that already exists in India.

That said, there have also been a few actors who have bucked the trend. Aishwarya Rai, Bipasha Basu and Chitrangada Singh have taken a stand against such creams saying that they generate discrimination based on skin colour. "You'll never find me endorsing fairness creams,'' Bipasha has been quoted as saying. 

Historical connection

Dr Hassan Galadari, assistant professor of dermatology, UAE University says in the past, being white was considered favourable as it indicated that the person was not a labourer and spent more time indoors, so was of a higher social order.

Social conditioning from an early age also has a role in people's desire to be fairer. Dr Saliha Afridi, clinical psychologist and director at Lighthouse Arabia, agrees that countries in Asia generally have a negative stereotype associated with dark skin, because it has typically been associated with people who are poor and unattractive. As early as preschool, children have been programmed to associate dark skin with negative attributes, which has triggered skin-lightening in everyone from celebrities to cartoon characters, reinforced by the media and even by parents, who tell their children to avoid being in the sun because it will make them ‘dark'. "Children who are exposed to such prejudices and stereotypes learn at an early age that being fair means being beautiful," says Dr Afridi.

"I think before a person attempts skin-lightening, it is important to think about why they are going through with it and what they hope it will accomplish." According to Dr Afridi, if the individual feels that lightening his or her skin will make them prettier, richer, more likely to get a promotion or a raise, they probably have low self-esteem and self-worth. 

Problematic ingredients

Aside from the cultural sensitivities associated with skin-lightening products, another concern is the potential danger associated with some of their ingredients. Most skin-whitening creams contain products that are harmful to the skin, including hydroquinone, mercury salts, hydrogen peroxide, magnesium peroxide or zinc peroxide. They can cause conditions ranging from skin problems to serious damage to organs such as the brain and kidneys.

Skin-lightening ingredients work in two ways - by absorbing ultraviolet rays and preventing the sun from darkening the skin, and by reducing the production of melanin, the pigment responsible for the darkening of the skin as a result of exposure to the sun.

However, experts say that apart from the dangers associated with some of the ingredients, the moment you stop applying the cream, the skin returns to its original colour.While there are many products that promise fairness, Dr Maria Angelo-Khattar, director, Aesthetica Clinic, Dubai, is quick to point out that skin colour is genetic and no chemical can permanently lighten skin. "Hydroquinone can produce temporary whitening effects, as can the heavy metals chromium and mercury, and both of these agents have been detected in most mass-marketed skin-whitening creams."

The mainstay of most whitening creams is hydroquinone - a possible carcinogen and neurotoxin (substance that affects the nervous system) that could cause ochronosis, an irreversible skin condition that results in black and blue lesions on the skin - which Dr Angelo-Khattar explains works by stripping the skin of its natural pigment. "However the natural pigmentation in dark-skinned individuals is the skin's natural protection from the sun," she says. Bleaching it will alter the skin's natural structure by removing and inhibiting the production of the protective colour, leaving it more vulnerable to sun damage. She adds that hydroquinone has also been found to damage connective tissue in the skin and cartilage, which could result in painful joint conditions.

Another disturbing trend that has been reported is the use of glutathione for whitening the skin, a chemical approved in the US only for treating cancer. Injected into the skin, it can whiten the colour by deactivating the enzyme tyrosinase, which helps produce melanin.

The FDA last year issued a warning that repeated injections of the drug could lead to kidney failure and blood poisoning, among other serious medical conditions. According to Dr Galadari, glutathione is a chemical compound produced by the liver to clear toxins from the body. "It has become popular recently and there have been reports of it being taken through injection especially in the Philippines," he says.

The obsession with becoming fairer can have fatal consequences. Sunny Hundal, writing in The Guardian, in London, reported that a skin-whitening cream was being blamed for the death of a 23-year-old Cambodian woman, who began vomiting after using the cream. "She was later rushed to a Thai hospital and pronounced dead," he wrote.

Another common ingredient found in many skin-whiteners is mercury, a highly toxic chemical which has been banned in Europe and America for use in skin-whitening products because it accumulates on skin and can have the opposite result in the long term, apart from leaving users with serious medical problems. Mercury can poison the bloodstream, and is highly toxic when used in cosmetics because it is readily absorbed, resulting in kidney, brain, nervous and gastrointestinal disorders; skin rashes, mood swings, memory loss, and muscle weakness.

The less dangerous kojic acid is a more recent discovery for the treatment of pigmentation problems and age spots. Discovered in 1989, kojic acid is now used extensively as a natural alternative to hydroquinone. Studies have shown that it is effective as a lightening agent, inhibiting production of melanin. While it is a natural ingredient, Dr Galadari points out that it can also lead to heightened skin sensitivity.

However, one of the most dangerous of all skin-whitening cream ingredients is monobenzyl ether, also known as monobenzone. Medically it's used in creams to treat uneven complexion or loss of skin colour, a condition known as vitiligo, which Michael Jackson claimed to suffer from.

It works by permanently removing colour from the normal skin located around the skin affected by vitiligo. But it should not be compared to hydroquinone or any other skin-lightening ingredient because it causes a permanent discoloration of the skin. Unlike skin-lightening creams, which only lighten the areas they are applied to, monobenzone applied anywhere on the body will lead to white patches at different areas. For example, if you applied monobenzone on your face, you could develop permanent white patches or streaks on your limbs and torso, because it travels through the blood stream.

Because monobenzone creams kill the skin's melanocytes - cells in the skin that produce and contain melanin - you can expect completely white and pinkish skin following depigmentation. However within one to two years, the skin may start to repigment itself, leading to a patchy appearance. Unlike the initial stage of using monobenzone, applying monobenzone to bleach these repigmented spots is unlikely to have any effect.

Going to extremes

Some people will go to great lengths to lighten their skin, even resorting to using steroids. A common component of some spurious whitening creams, steroids can cause thinning of the skin and/or stretch marks, cellulite, contact eczema, bacterial and fungal infections, Cushing's syndrome - a hormone disorder that can cause weight gain and rounding of the face due to fat deposits - acne, skin atrophy and pigmentation disorders.

Steroids, says Dr Galadari, contrary to popular belief, are not bleaching agents. "Steroids affect cell turnover, including cells that produce pigment and cause them to produce less; a higher concentration [of steroids] can lead to skin atrophy where the skin feels paper thin and is very dry and fragile," he says.

One of the biggest problems with skin-whitening products is the fact that virtually anyone can compound and create a product using any of the above ingredients, not fully understanding the side effects or risks associated with long-term use.

Dr Angelo-Khattar suggests that even when using a good, reliable and expensive product, rigorous sun protection must be practised, such as the application of a sunscreen at least once or twice daily. "In general, people who use bleaching products can develop rough and blotchy skin and can get caught up in the ‘bleaching trap' by using more cream to try and correct the problem and in so doing find themselves causing even more damage to their skin," she explains.

However the responsibility for the impact of using whitening creams is not the individual user's alone, but also that of the society that promotes such standards of beauty, says Dr Afridi. "If people are lightening their skin to be socially accepted, then it is likely that they have low self-esteem or likewise, if people are making changes to their skin colour because they want more attention, validation, or love then usually they are afraid of rejection or afraid of being alone," she says. These people may feel that they will not be accepted or achieve high status in their society if they do not fit the idea of beauty that society promotes - unfortunately often a very narrow standard of beauty.

But in the end, is it worth getting that fairer complexion, even for a short while, if it just means ending up with skin problems or, worse, a serious health condition?

Case studies

For whitening creams

Anita*, 42, an engineer in Dubai:

"I've been using a special homemade whitening cream that a friend of mine prepares at home for the past year. I never asked her what it contains but she tells everyone who buys it that it is a mix of five secret ingredients.

"My reason for using it is pretty complex. Growing up in Delhi, India, where most people are fair-skinned, I believed that the ideal beauty is always fair-skinned.

"My two younger sisters had complexions that were much lighter than mine and I was constantly referred to as "the dark one."

"As far back as I can recall, well-meaning relatives commented on my rich cocoa-brown skin, in a derogatory manner, or sometimes with a hint of sympathy.

"My parents always told me that skin colour was just superficial, but I had figured out early on that I'd never be considered as pretty as my sisters.

"Once I hit my teens, I began using a skin-whitening cream. But when I did not find much success with it, I moved to another brand, then another... In college I met a girl who boasted about a cousin who created her own whitening cream at home, but for an exorbitant price. It was ‘guaranteed' to give a lighter and whiter complexion.

"I purchased the cream a year back and have seen great results. I have no idea what the ingredients are but trust me; my skin has become noticeably lighter in colour. I have had people comment on how fair I look.

"But there is one problem; whenever I stop using it for even more than two days in a row, the darker patches begin reappearing. When I asked my friend, she just shrugged it off and told me I would probably need to use it all my life...

"I have read that there are dangers in using such whitening creams but I personally don't know anyone who has suffered from them and well, I suppose it is like a smoker who is warned of the dangers of smoking yet personally does not know of anyone who has been affected...

"All I know is that it works and even my friends are commenting on how fair I look.''

Against whitening creams

Hind*, a 21-year-old student in Dubai:

"I am in my final year in university. I've never used a whitening cream in my life, although I have plenty of friends who do so. I have a wheatish complexion but never really gave it much thought, nor have I ever been singled out based on my skin colour. However, in college, my parents were excited about a marriage proposal I received. The individual was educated. While I wanted to further my education I was excited deep down. I had seen the man a few times and found him attractive. Yet when the family came to meet me, the first thing his mother and sisters uttered was how dark I was in real life compared to the photos they'd seen of me! I was embarrassed and shocked to say the least. While my mother tried to change the subject, the end result of the meeting was that his mother rejected me because I was, according to her, too dark for her son. It was disturbing to see people in this day and age rejecting or accepting a person based on superficial qualities like skin colour."

*Names have been changed.