The language of fairness may be changing, but the desire for lighter skin has not necessarily disappeared in our country. As skin-lightening practices move into skincare, dermatological procedures and digital spaces, the health consequences are becoming increasingly harder to recognise and regulate.
What has changed
Skin lightening in India is changing. The fairness creams that once dominated advertisements are less visible today. The language around them has also shifted. Words such as ‘brightening’, ‘glow’, ‘de-tan’ and ‘even tone’ are now common across skincare products and digital platforms.
For dermatologists, this change is increasingly visible in clinical practice.
Patients may not come to the clinic saying that they have been trying to become fairer. They often present because something has already gone wrong. There may be acne, redness, thinning of the skin, increased facial hair, pigmentation or infections. Oral agents used with the expectation of achieving lighter skin are also being sought.
“We see patients because of the side-effects of what they have tried, and then work backwards,” says Rashmi Sarkar, head and director – professor, department of dermatology Vardhman Mahavir Medical College and Safdarjung hospital, New Delhi.
The profile is changing too. What was once viewed largely as a concern among women is now also seen among men, teenagers and transgender persons. This makes skin lightening an important skin-health issue, rather than simply a cosmetic concern.
Where treatment ends, lightening begins
Not all treatment that reduces pigmentation is skin lightening.
Melasma and post-inflammatory hyperpigmentation are common pigmentary disorders. They can be persistent and distressing, particularly in darker skin tones. These conditions may require treatment.
The important distinction, Dr. Sarkar says, is between treating a pigmentary disorder and attempting to lighten a person’s normal, constitutive skin colour.
This distinction is becoming less clear to consumers.
A product described as ‘brightening’ may be intended to reduce pigmentation, improve dullness or make the skin appear more even. The term itself does not explain what is being changed.
For clinicians, the focus should remain on skin health. Brighter-looking skin can follow better photoprotection, appropriate skincare, control of inflammation and improvements in general health and lifestyle. None of these requires changing a person’s natural skin colour.
The digital shift
The larger change is taking place online.
Skin-lightening messages are no longer limited to television advertisements or product packaging. They are increasingly delivered through influencers, e-commerce platforms, before-and-after photographs and social media.
Algorithms can amplify these messages. A person who watches one video on pigmentation may subsequently be shown repeated content around brightening products, supplements, peels or procedures. Filters and image manipulation add another layer. Photographs can be altered to make skin appear lighter, smoother or more uniform. Artificial intelligence can make these alterations increasingly difficult to recognise.
Dr. Sarkar believes public education, must therefore, also address digital literacy. People need to learn to recognise filtered or manipulated images and to question the aesthetic standards repeatedly presented to them online.
The impact is particularly relevant for younger users. Repeated exposure can gradually alter what is perceived as normal skin and what is considered a problem requiring correction.
When treatment becomes excessive
The growth of aesthetic skincare has also widened the number of places where people seek treatment.
Patients may move between dermatology clinics, aesthetic centres, salons, spas, social media and online marketplaces. The distinction between medical treatment and cosmetic marketing can become unclear.
Dr. Sarkar stresses that pigmentary disorders should be assessed by qualified dermatologists. Procedures also need to be selected carefully and patients should not be overtreated. This is particularly relevant in darker skin tones, where inflammation caused by aggressive treatment can itself lead to further pigmentation. The treatment can then become part of the problem.
There is also a role for clinicians in managing expectations. Not every variation in skin colour requires treatment. Unregulated over-the-counter skin-lightening products should be avoided and unrealistic expectations need to be addressed early.
The health consequences can be significant. The ILDS has warned that the misuse of potent topical corticosteroids in skin-bleaching products can contribute to treatment-resistant fungal infections, irreversible skin damage and systemic side-effects. The organisation has called for stronger regulation, clearer guidance and better public education.
Beyond the clinic
The response to skin lightening therefore also needs to change.
Traditional awareness campaigns remain important, but they may no longer be sufficient when much of the contemporary conversation is taking place online. This is a particular focus of the ILDS Strategic Working Group on Skin Bleaching. The group brings together international dermatology expertise to address harmful skin-lightening practices while also recognising the legitimate need for safe, evidence-based treatment of pigmentary disorders.
The message, says Dr. Sarkar, who is part of the Working Group, needs to reach people where these practices are now being discussed and promoted. “We need to leverage social media and amplify the message,” she says. This includes closer collaboration between the ILDS and national dermatology societies, as well as engagement with pharmacists, educators and credible public voices.
India has previously seen organised campaigns around inappropriate topical steroid use. These efforts included education of both patients and pharmacists. A similar approach is now needed for contemporary skin-lightening practices.
The ILDS initiative also has a wider aim: to move the conversation away from skin colour as an aesthetic hierarchy and towards skin health. The message is simple, but important. Healthy skin exists in every shade.
Patients, regulators need to be in step
For those experimenting with skincare routines, particularly skin lightening, it means understanding the difference between a pigmentary disorder and normal skin colour. It means recognising that medicines used without appropriate supervision can damage the skin. It means knowing that repeated procedures are not always better treatment. Increasingly, it also means understanding that the images seen online may have been filtered, lightened or otherwise altered.
Regulation will need to evolve alongside this change. Looking only for products explicitly labelled as ‘fairness’ products will miss part of the contemporary market. Claims, ingredients, digital advertising, influencer marketing and access to potent medicines all require attention.
But regulation alone cannot address the deeper issue.
Greater awareness has made overt fairness advertising less acceptable. Yet, as Dr. Sarkar points out, social perceptions around skin colour continue to persist.
The challenge is therefore no longer only the fairness cream. The language has changed. The platforms have changed. The people seeking these interventions are also changing. The response now needs to change with them.
For dermatologists, professional societies and public-health organisations, the opportunity lies in moving beyond treating complications after they occur. The focus must be on prevention, evidence-based care, digital education and a clearer understanding of what healthy skin actually means.
(Dr. Monisha Madhumita is a consultant dermatologist at Saveetha Medical College, Chennai. mail.monisha.m@gmail.com)