• Dermatologists weigh in on genetics and uses of skin colour, and the myths and perils of personal identity and skin whitening

One’s natural skin colour is a part of one’s identity, and it is determined mainly by genetic factors. When it comes to Sri Lankans, who are inhabitants of a warm, Asian country, having a tan or brown skin colour is not only natural, but also provides a number of benefits. However, despite this, due to various beliefs triggered by social norms and marketing campaigns, there is a tendency among Sri Lankans of various age groups to artificially whiten their skin colour using various skin products, which recently attracted attention due to the questionable nature of such products available in the market. Taking into account the great health risks associated with the use of unsafe products, some of which became a topic of discussion during the past few months, it is high time for the public to understand their responsibility in not succumbing to the urge to obtain fair skin easily.

This was the response of medical professionals to the prevailing trend of using various skin products to have fair skin, which, in the past few months, caused controversy. As per the reports, while many such products available in Sri Lanka contain harmful substances, the contents of some remain unknown. There are also ample reports of the adverse health conditions caused by some of these products, which have now attracted the authorities’ attention. This situation was discussed during a discussion held by the Health Ministry’s Health Promotion Bureau, which was attended by the President of the Sri Lanka College of Dermatologists and dermatologist at the Lady Ridgeway Hospital for Children, Dr. Sriyani Samaraweera, and dermatologist at the National Hospital of Sri Lanka (NHSL), Dr. Indira Kahawita.

Protecting the natural skin colour

Noting the importance of understanding how one’s natural skin colour is determined by genetic factors, Dr. Samaraweera said: “Our skin colour is determined by melanin. Unlike certain other organs, our skin is an organ that renews constantly. It takes 28 days for this (renewal) cycle to complete, which means that our skin colour renews every 28 days. Therefore, whatever methods we use to change the skin colour, it has to be a continuing process. In addition, our natural skin colour may change due to various diseases. Such colour changes may be limited to certain parts of the body or spread throughout the body. What is more, frequent exposure to the sunlight may darken one’s skin.” She opined that the tan skin that Sri Lankans have is a gift from nature for those who live in hot countries, as it could minimise the adverse impacts that could be caused by sunlight.Changing this natural, beneficial skin colour, she said, could result in harmful results. “The sunlight could, to a certain extent, darken our skin. By covering our skin, we can protect our skin colour. 

However, we all need Vitamin D in order to maintain good health. If one has a skin disease, we advise them to be careful from sunlight, while those who do not suffer from such conditions are advised to obtain the minimum amount of sunlight to produce the necessary amount of Vitamin D. In addition to protecting us from sunlight, tan skin has a number of benefits. In fact, with age, photoaging (damage the sun does to the skin) becomes more common in those with fair skin than in those with tan skin. Skin cancer is another pertinent issue, which is prevalent in European countries and in countries like Australia. Thanks to the protection provided by the high prevalence of melanin in our skin, we are less susceptible to skin cancers. In addition, we have recently noticed an increase in skin cancers in Sri Lanka, although we are yet to find out the causes.” Dr. Samaraweera stressed that fair skin does not constitute healthy skin and that what is important is having healthy skin and protecting one’s natural skin.

Attitudes and responsibilities

Meanwhile, Dr. Kahawita raised concerns about the lack of vigilance on the part of the public when it comes to skin fairness products. Describing the public’s behaviour when interacting with social media posts that promote such products, she pointed out that although many inquire about how soon such products can help one have fair skin and their prices, only a handful question about the contents of such products, how safe such products are, where they were manufactured, or whether they have received the necessary permissions and registrations. “This is where the issue is. We have succumbed to the myth that fairness is equivalent to beauty, which is on the rise. In the past, the aim was to be fair. Gradually, people wanted to have extra fair, bright skin, and now, they want to have it fast,” she said, emphasising that there is an attitudinal issue at the centre of this matter, and that marketing activities and social norms that assign a high value to having fair skin have equated fairness with beauty.

With regard to the discussion on whether one could have fair skin in a safe manner with the help of a qualified dermatologist, Dr. Kahawita said: “As professionals, we have a certain responsibility. We cannot help someone have fair skin overnight. Instead, if we are helping someone to make some kind of change to their skin colour, what we recommend is a gradual process. However, Sri Lankans do not have the patience it requires. We also educate them about the possible side effects of the products that they use. However, they do not see these as relevant. Usually, when we provide the relevant guidelines, people tend to seek easier ways to attain fair skin.”

The skin whitening racket

In response to a question about those who claim to provide various skin related services, including the whitening of skin, with minimum or insufficient qualifications, Dr. Samaraweera said that the authorities’ attention has been drawn to the matter, and that plans are afoot to raise awareness among the public about such. However, there is also a legal aspect to this issue which is yet to receive adequate attention, according to Dr. Samaraweera: “There is also an issue of cosmetics having been removed from the National Medicines Regulatory Authority (NMRA) Act as the regulation of such was deemed unnecessary. But, we resumed regulating cosmetics in 2015, since a large number of cosmetic products were registered under the NMRA. We can assure that all such products that were registered in that manner were subjected to necessary tests to ensure their effect on health. The advice we can give the public is to only purchase products that have been registered in Sri Lanka. As per the prevailing law, no person is permitted to produce any product that is applied on the skin without permission, and only those who have obtained permission from the NMRA are allowed to engage in such. However, there is no issue in the legal provisions that enable the Consumer Affairs Authority (CAA) to conduct the necessary raids.” During the discussion, Dr. Kahawita explained that based on investigations conducted into improperly manufactured skin whitening products, Dr. Kahawita explained that extremely excessive levels of heavy metals were present in such products. 

Although the ideal, safe level of heavy metals that could be included in such products is one milligram (mg) per kilogram (kg), in some cases, 27,000 mg had been present per kg, while even the lowest amount of heavy metals that were found in such products was eight times higher than the abovementioned safe level. In addition, with regard to those identifying as ‘cosmetics specialists’ who she said may or may not be qualified doctors, it is not possible, according to her, even for a qualified doctor to officially use the terms ‘cosmetics specialist’ or ‘cosmetics physician’ in Sri Lanka, as no doctor receives trainings specifically to become such a professional. Noting that those who provide skin whitening services under such labels aim at making money over providing quality services, she pointed out the responsibility on the part of the public and of the health authorities in dealing with this situation.