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October 01, 2017 Sunday 11:56:50 AM IST

The Fairness Fad: Insecure in Our Skin

Health Monitor

We grow up hearing this and as a  dermatologist, you could expect that I see/hear this everyday in my consulting room. Well, I do hear it, different shades of this anguish!

 

“Doctor! My face is erupting into pimples! Help”!

 


“Doctor! I have white patches here”!

 

“Doctor! Please make my scars better”!

 


“Doctor! I want to be fair.”

 

I’ve not mentioned the more serious complaints of scaly psoriasis, itchy eczemas or growing skin cancers. But there’s just one which bothers me and troubles my thoughts - “Doctor! I want to be fair.”

 


A few days ago, I had the routine follow up consultation of a 19-year-old charming, dusky young girl. She had had a sun allergy with patches on her arm and face which was satisfactorily clearing with treatment. As I was reinforcing the importance of sun protection, she was distracted and kept looking at the mirror on my table. I remarked that her face was almost clear and sunscreens would do. At this point she looked up and said: “I want to be fair”!

 

Though I have heard this a hundred times before, with her it was different. For a moment I was taken aback. I looked at her. She was dead serious. Gone was the chirpy, bubbly, cheer I had seen in her. I looked at her mother for a clue. There was none.

 


“Why do you feel that way? You are charming. Don’t you know that”? I told her. She looked at me. “In college,  nobody calls me to present a bouquet to a guest. Why? They call only the “fair” ones.

 

“Doctor, you may not think it’s important to be fair, but do you know the number of opportunities I’ve lost because of my colour?” She was quiet. There was tremble on her lip and a tear in her eye. I took a deep breath. This was  ore than just skin deep. Once again, the “fairness monster” had raised its ugly head.

 


I invite every parent reading this to consider the situation. What would your response be? As we powder our faces, put on makeup or Photoshop our Selfies on the phone, we are all victims of the same “beauty is skin deep” truth. Therefore, to be fair is to be beautiful. This need to be fair has become an obsession in Indian society. We, of Aryan, Mongoloid and Dravidian descent, have a range of skin colours and tone. There is precious little we can do to avoid this genetic DNA coding of our shades of brown other than making voluntary choices of mating with the Caucasian (White) races to bring about unusual hues of lighter colour and skin tones in our next generation.

 

Can we become fairer? Let’s look at some myths and the facts around it. So, what gives us our skin colour? It’s the pigment Melanin.

 


Why then do we appear darker (tanned) after a day in the sun?

 

 Melanin is produced by skin cells called Melanocytes. These cells are stimulated to produce more melanin containing melanosomes in the skin on exposure to sunlight. And why does the body do this? Because this melanin protects the underlying sensitive skin cells and structures from harmful UV rays. This is of vital importance as prolonged UV rays can cause cancerous changes in susceptible skin cells. This automatically explains why countries closer to the Equator have darker skin tones than those in the temperate regions.

 


We need to be grateful for our “natural brown umbrella” which protects us from the harmful rays of the sun, hereby resulting in much lower incidence of melanomas and other such cutaneous cancers compared to our “white” counterparts of the Western hemisphere.

 

However, all skin types on exposure to the sun temporarily darken a few shades for this same reason. This “tan” fades away spontaneously in roughly a week’s time.

 


Herein lies the role of the sunscreen. By applying the sunscreen at regular intervals, we protect our skin from the sun’s rays and prevent the excess melanin production which leads to lesser tanning.

 

And this sunscreen is invariably a component of many “skin whitening” creams.

 


That bring us to the craze of fairness creams in India which capitalizes on the Indian obsession of “fairness” and outsells Coca Cola at this point. Do they work? If so, how?

 

The first step of Melanin synthesis involves Tyrosine –>DOPA with the help of enzyme Tyrosinase. Many substances: Hydroquinone, Kojic acid, Arbutin reduces this conversion and hence Melanin production temporarily. This means on the days the cream is applied, there is a small reduction in pigment production.

 


These substances used over the years may make one “fair & lovely”, but what happens if it is used for many years?

 

Like one of my 45-year-old patients discovered that no amount of a particular fairness cream was making her fairer anymore like she had experienced at the age of 13. Over the last 30+ years, she had slowly turned an unhealthy bluish black shade, a condition called Riehl’s Melanosis. This is a cruel dark joke played by long term abuse of fairness products. And the worst part is permanent pigmentation. Stopping of the cream won’t reverse this condition!

 


So, in the last couple of decades we have inadvertently become more insecure in our own skin!

 

What do we do about this? Where do we start?

 


Let’s start at the beginning, while people are still young.

 

Having worked with ENFOLD, a Bangalore-based NGO which educates and works for the prevention of child sexual abuse, I want to share a few of their vital messages.

 


As a key step in preventing abuse, the child is made to feel its worth, no matter how small. Only if a child is confident of himself/herself will it have the courage to stand up to a bigger bully or predator. This is vital as the profile of abusers say they prey on young ones who are insecure and fearful, as evidenced by their body language.

 

A wee bit of low esteem including physical disabilities, so-called unattractiveness, use of glasses/ braces, or just a darker skin tone can result in an inferiority complex and cause emotional scarring, thus making them easy prey.

 


One of ENFOLD’s cardinal rules says, never praise a child for his/her looks. We don’t say, “What a pretty child! Instead we say, “You have groomed yourself nicely today. Well done”!

 

During our sessions with the children, we place emphasis on SKILLS, on what they can DO: Draw, sing, study, run, play or dance rather than on what they are born with. This is the best way to teach a child to build self-esteem.

 


That’s what I did with my patient. She required some of my time, but the results were worth it. She went out of my room saying, “I shall aim to get the bouquet, not give it.


Dr. Preethy Harrison

Senior Consultant, Department of Dermatology, Rajagiri Hospital, Kochi

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