Classmates would bully Fatima Lodhi, taunting her and other darker students with derogatory names.
It got worse as she got older. In high school, she was nominated for the "Makeover Required" category in her high school in Islamabad, Pakistan. And in graduate school, fellow students would yell "let's paint her white" whenever she crossed their paths.
"All this was done by my light-skinned fellows, just to make me feel bad," said Lodhi, a 28-year-old early childhood educator who started the anti-colorism campaign Dark is Divine in 2013.
The campaign conducts classes online and in schools on media literacy, confidence-building and inclusion, with the goal of teaching people to embrace themselves and be comfortable in their own skin. It has now reached more than 20 countries.
"Light skin, white skin, is still considered the ambassador of beauty," Lodhi said.
A recent study found that more than half of 1,992 men and women surveyed about product use in India had tried skin whiteners, and close to half (44.6%) felt the need to try such products due to media such as TV and advertisements.
Globally, the demand for whiteners is climbing, projected to reach $31.2 billion by 2024, up from $17.9 billion in 2017, especially in Asia, the Middle East and Africa, according to market intelligence firm Global Industry Analysts. Routine skin whitener use ranges from 25% in Mali to 77% in Nigeria, and it's 40% in China, Malaysia, the Philippines and South Korea, according to the World Health Organization.
Asia's growing market
But when it comes to these products, the Asia-Pacific market is the most lucrative region, making up more than half of the global market -- an estimated $7.5 billion out of $13.3 billion -- in 2017, according to Future Market Insights, which studies markets in over 150 countries. China accounts for about 40% of sales in Asia, Japan 21% and Korea approximately 18%.
"In East Asian culture, women prefer lighter skin tone because they believe 'yī bái zhē bǎi chǒu,' which means 'a white complexion is powerful enough to hide seven faults,' " said Shuting Hu, who researches new ingredients for whiteners, looking at the mechanism in skin cells at the molecular level. She is executive director and co-founder of SkinData Limited Hong Kong, a technology startup based on her research at the University of Hong Kong.
And, as Lodhi found in childhood, darker skin signified more than just a mark against beauty.
"In many societies, especially in Asia, skin color was long seen as a sign of social class," said Evelyn Nakano Glenn, a University of California, Berkeley, professor of gender and women's studies and ethnic studies. "With Western colonial incursions during the 18th and 19th century, the light skin of European colonizers became a marker of higher status, while the darker skin of Asians/Filipinos became a marker of colonial subjugation."
Rachit Kumar of Future Market Insights added that "the demand is expected to continue to grow despite their potential health dangers. Asian consumers are highly concerned regarding their beauty and hence tend to spend more on such products, particularly the current generation of consumers in their teens who tend to have a significant beauty budget."
Kumar attributes the rise in demand in Asia to these consumers, who are "ready to spend millions of dollars in order to enhance their overall appearance."
Cosmetic manufacturers are launching skin-lightening products on a regular basis in order to cash in on this lucrative business.
Hu herself has tried most of the skin whiteners on the market, using them to treat acne marks or to even out her skin tone after a tan, she said. But she also grew up under pressure to be fairer.
"When I was very young, my parents, my friends and the superstars on TV all deliver a message that a whiter skin tone is pretty. So in this culture, you will be influenced and be one of them," she said. "Personally I don't want to be whiter, just keep healthy skin. Only after suntan, I want to be whiter, back to my original skin tone."
However, she adds that many products need to keep up to date with research.
"Most of the whiteners are using outdated, at least to me, active ingredients," she said. "So personally, I prefer to try something new and novel."
The limit to skin whitening
"The color of our skin is determined by melanin, which is produced by melanocyte, a type of skin cell. Everyone has different numbers of melanocytes, and that's why we have different skin colors," Hu said. "It's impossible to change your gene or race, so there is a natural limit to whitening effects that you can achieve through using skin care products."
Seventeen percent of those surveyed in the recent study in India reported adverse side effects from whiteners, yet only 3.1% sought help from a health professional.
"It is impossible to make one's own skin color lighter than one is born with," said Dr. Soyun Cho, professor of dermatology at the Seoul National University College of Medicine.
Cho explains that because Asian skin has more melanin than Caucasian skin, inflammation can lead to postinflammatory hyperpigmentation, or discoloration, which usually goes away within a few months but can last indefinitely.
Most commonly, people can develop contact dermatitis, an inflammatory reaction due to allergy or irritation, Cho said, leading to redness, itching, edema and heat. It can take two weeks to clear but can also lead to postinflammatory hyperpigmentation.
"The most dangerous thing is trying to whiten the skin in a short time, but still, some people keep doing it," Hu said. "I think the reason is, they don't know it results in serious problems to the skin," such as allergies or depigmentation.
This year, the Japanese cosmetic company Kanebo paid damages to an additional 44 women, after reaching settlements with more than 18,000 women who developed blotches after using the company's whiteners. Nearly 20,000 customers reported white patches, or chemical leukoderma -- depigmentation -- after using products that contained the whitening chemical Rhododenol.
The company recalled 54 products containing the chemical in 2013.
The World Health Organization says that 61% of skin products in India are aimed at lightening, and when 23 skin fairness creams in India were tested by the International Journal of Pharmacy & Technology, almost half were found to contain steroids.
"There is no regulation of these products, and the advertising industry was using actors and spokespersons to promote these products as a way to enhance the desire for the product," said Hemal Shroff, lead researcher on the study and associate professor at the School of Health Systems Studies at the Tata Institute of Social Sciences in Mumbai, India.
Shroff's study cites a range of side effects, depending on the whiteners' ingredients. Products that contain hydroquinone, steroids or mercury can cause "irritation, inflammation, thinning of skin, scarring, abnormalities among newborn babies if used during pregnancy and breast-feeding, and kidney, liver or nerve damage."
Mercury in skin-lightening products can also cause reduced resistance to bacterial and fungal infections, liver damage, anxiety, depression or psychosis, according to the World Health Organization.
These ingredients are banned in cosmetics in the EU and Korea, but Cho said imported cosmetics found online could include them.
Whitening safely
But Hu believes that there is a safe way to whiten, if allergies and ingredients are taken into account.
"The way to achieve is not by killing your melanocytes but to inhibit the synthesis of melanin or accelerate the removal of existing melanin," Hu said.
She advises looking for a regulated product from an authorized dealer, being patient and continuing to use the product as long as you're not allergic to it, plus reading and understanding the ingredient list. She says that products with vitamin C are not stable and better used within a month, whereas those with hydroquinone, a compound that helps limit skin from creating an excess amount of melanin, can be used only with a doctor's prescription.
There are also different rules governing products in Asia. For example, Hu says, cosmetic products in China require approval from the China Food and Drug Administration, which she describes as "one of the most strict regulation on skin whitening worldwide." There is an ingredients approval list but no limit on their concentration. For an ingredient to be added to the list, registration is required and could take years of research and a lot of investment.
In Japan, skin-whitening products are labeled as "quasi-drugs," Hu said, with an ingredient approval list and concentration limit. Tests on new ingredients could also take time and money.
And in South Korea, whitening products are classified as "functional cosmetics," and evidence is needed to "substantiate claims or advertisements," she said.
Cho says that although these cosmetic products are safer, the effects are minimal.
"They are just cosmetics, not medicine, so one shouldn't expect dramatic whitening with cosmetics," Cho said.
But Hu and Cho agree that the best way is prevention, specifically wearing sunscreen.
Changing attitudes
With high demand and the large amount of products available, Shroff said, more regulation and programs are needed to teach people about potential side effects.
"Governments should support or initiate social programs that encourage people to appreciate diversity in skin color and not make simple connections between being fair and being beautiful and successful," Shroff said.
And Lodhi stresses that in the end, it's all about feeling comfortable in your skin.
"Being a victim of colorism, I could relate to how it feels when someone mocks at your for something that is God-gifted, your looks, and you have no control over it," she said.
"I didn't want anyone to go through what I have been through and wanted to change the negative connotation of the word 'dark.'"
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