A growing number of Nigerian kids younger than five may be exposed to skin-lightening products, suggests research published in BMJ Open.
Most (80%) of the respondents’ children who were exposed to skin-bleaching products were under two, and knowledge of the health risks of the practice was trumped by aesthetic preferences for lighter skin tones, the survey shows.
To better understand the prevalence and motives for the practice and inform policy to safeguard children’s health, the researchers surveyed 369 mothers with at least one child under five in Ile-Ife, Osun State, Southwestern Nigeria.
The mothers were all attending community immunization and infant welfare clinics in three government-owned primary healthcare centers. The questions aimed to find out how many of them used skin-lightening creams, soaps, or lotions on their young children and to explore their knowledge, attitudes, and perceptions of the pros and cons of these products. Potentially influential factors, such as age, marital status, religion, income, occupation, cultural beliefs, educational attainment, personal skin color, use of skin-lightening creams, perceived social factors, and access to media, were all taken into account.
The average age of the mothers was 30, and nearly all had attained at least secondary level education. Most (87%; 320) reported low household income. Between them, they had 792 children, ranging in age from one to 59 months. Around one in five (19.5%; 72) of the mothers said they used skin-lightening creams on their children. Of these, 90% (65) applied the products routinely; the rest used them intermittently.
Infants and young children were the primary recipients. Over three quarters (81%; 58) of those exposed to these products were under two, with more than half (51.5%; 37) being six months or younger.
Children under two were twice as likely to be the recipients of skin-lightening attempts as older children. The most frequently used agents were hydroquinone-based creams (60%; 43), followed by powerful topical steroid creams (29%; 21), the survey showed.
Three quarters (76.5%; 55) of the mothers who used skin-lightening products on their children self-identified as light-skinned, and a similar proportion (75%; 54) expressed a preference for lighter complexions.
Most of these mothers (89%; 64) said they had used skin-lightening creams on their own skin, and 56% perceived lighter skin as conferring social or economic advantages over darker skin tones.
The most frequently cited reasons for the use of skin-lightening products were to improve the child’s complexion (61%; 50) and to preserve or maintain what was described as the child’s natural skin color (79%; 65).
Less than half (43%; 31) of the mothers cited specific perceived benefits of skin lightening, including the treatment of blemishes (8%; six), enhancement of beauty (19.5%;14), or prevention of darkening from sun exposure (6%; four).
Skin-lightening products often contain endocrine system disruptors, such as liquorice, resveratrol, steroids, as well as heavy metals, such as mercury, they point out.
Almost all the respondents (97%) were aware of the health risks associated with these products, and most (81%; 58) of those using them on their children were aware of at least one serious systemic side effect associated with use.
Fully one in three survey respondents acknowledged the potential presence of toxic substances in some of these formulations. But they were around four times less likely to acknowledge specific dangers or identify complications than those who didn’t use these products.
Mothers who had used skin-lightening creams on themselves were 15 times more likely to use them on their own children than those who didn’t report personal use, while perceiving light skin as more attractive or socially advantageous nearly doubled the odds of early childhood exposure.
And having a family member who practiced skin lightening was also associated with a doubling in the likelihood of using one of these products on a child.
“Beyond physical health implications, these practices also transmit colourist ideals, positioning lighter skin as a marker of beauty, self-worth, and social acceptance,” the study authors note. “Such early internalisation may adversely affect self-concept and identity, reinforcing intergenerational cycles of dissatisfaction with natural skin tone, stigma, and harmful cosmetic norms that persist across the life course. The dual risk of toxic exposure and early internalisation of colourist ideals from childhood skin-lightening carry profound public health implications. While risk awareness may contribute to reducing the practice, cognitive dissonance may undermine its impact.”
To address mounting concerns over the misuse of skin-bleaching products, the International League of Dermatological Societies (ILDS) issued an updated position statement on the Safe and Appropriate Use of Topical Corticosteroids. The ILDS points out that skin-bleaching is widespread in some regions of Africa, Asia, South America, and the Caribbean, where it is driven by sociocultural pressures that favor lighter skin tones.
The updated ILDS position statement calls for:
- the stricter regulation and enforcement of regulations that prohibit the use of monotherapy and/or fixed-dose combinations, containing potent or super potent corticosteroids without a prescription from an appropriately trained healthcare professional
- clearer guidelines to protect patients and the public from the risks of overuse and misuse of potent topical corticosteroids
- improved patient and public education on the dangers of skin-bleaching
- advocacy efforts to promote safer dermatological practices globally
