It might be a bigger problem in other parts of the world, but Australia is not immune to it, says a leading Sydney dermatologist.
Unsafe skin bleaching has become an under-recognised public health crisis, with millions exposed to toxic products and growing use among adolescents prompting a global education campaign from a new international dermatology taskforce.
The world’s largest dermatology organisation, the International League of Dermatological Societies (ILDS) has launched a new international taskforce to tackle the growing health risks associated with skin bleaching, warning that the practice has evolved into a major but under-recognised public health problem affecting millions of people worldwide.
While the problem is more widespread in countries like India, Africa, and parts of Asia, Sydney dermatologist and treasurer of the ILDS, Professor Stephen Shumack OAM, told Dermatology Republic Australia was not immune.
He said it was increasingly relevant for Australian clinicians, particularly those caring for culturally diverse communities.
“It’s not that common,” Professor Shumack said.
“But you’ll find that, particularly women, but sometimes men from Africa, India and various Asian countries, are importing this stuff into Australia.
“What they’re doing is they’re either bringing it across themselves or getting it sent from people there.
“There are some fading products available in Australia, but for the higher concentration you need to go to the pharmacies to get it needs to be compounded [with a prescription].”
The ILDS has established a Strategic Working Group on Skin Bleaching, bringing together dermatologists, a health psychologist, and an anthropologist to coordinate global education, advocacy, and policy efforts aimed at reducing the harms associated with skin lightening products.
The move comes amid mounting concern over the widespread availability of poorly regulated skin bleaching products, many of which contain potent topical corticosteroids, mercury, or other toxic ingredients that can cause serious dermatological and systemic complications.
It also follows the ILDS’s release of a position paper on the topic last year.
The ILDS Movement for Safe Skin – Challenging Harmful Skin Lightening Practices, will focus on educating consumers, supporting healthcare professionals, and working with communities to promote safer approaches to skin health.
Chair of the working group Professor Ncoza Dlova said skin bleaching was increasing across many parts of the world at an unprecedented rate and demanded a coordinated international response.
“The practice of skin lightening is increasing rapidly around the world to the extent that it’s now a serious but unrecognised public health burden,” Professor Dlova said.
“Our Working Group brings a multidisciplinary approach to this complex and challenging problem and will deliver structured, evidence-based action and advocacy.”
She said the campaign was intended to encourage healthier attitudes towards skin colour while recognising that many patients with pigmentary disorders sought legitimate medical treatment.
“We recognise that hyperpigmentation disorders are a significant concern for many individuals with darker skin tones and can impact their quality of life and self-confidence,” she said.
“Our campaign advocates for safe, evidence-based treatments and informed choices, while raising awareness of the dangers of unregulated and harmful skin bleaching products.”
Skin bleaching is driven by complex social and cultural factors, including longstanding beauty standards that associate lighter skin with attractiveness, status or opportunity. While the practice has historically been most prevalent across parts of Africa, Asia, the Middle East, and the Caribbean, dermatologists say demand is also increasing within diaspora communities and among men.
The ILDS cited estimates suggesting around three-quarters of women in Nigeria regularly use skin lightening products, while prevalence has been reported at about 50% in Senegal. Studies from northern India have also found skin lightening products are commonly used.
The organisation said one of its greatest concerns was evidence that skin bleaching products were increasingly being used by adolescents and, in some communities, even very young children.
The consequences could be severe, Professor Shumack told DR.
High-strength hydroquinone may cause permanent pigment changes, while mercury-containing products carry the risk of neurological toxicity. Potent topical steroids can produce acne, skin thinning, visible blood vessels, and even suppress the body’s normal steroid production.
“Some people use mercury, and that causes all sorts of problems with the nervous system,” Professor Shumack said.
“Other people then put in quite highly potent topical steroids because that actually causes some skin lightening as well, and that in itself can cause acne, skin thinning, broken capillaries, and sometimes there’s even so much that it causes a bit of suppression of the body’s normal ability to produce steroids itself.”
The complications extended beyond the physical effects, and Professor Shumack welcomed the ILDS decision to include psychological expertise within the working group, noting that many people seeking skin bleaching already experience significant appearance-related distress.
“People start using these things because they’re worried about their appearance,” he said.
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“The trouble is they use stronger and stronger products. They end up getting skin side effects from those products, and these people have already got a slightly fragile self-awareness issue.
“They spiral into a sort of depression and won’t go out.”
The working group also highlighted concerns that consumers frequently obtain these products without medical advice through informal retail outlets or online marketplaces where regulatory oversight is limited.
Former American Academy of Dermatology president Professor Seemal Desai said clinicians around the world were already seeing the consequences.
“Every day, dermatologists around the world see patients who have suffered harm from skin bleaching products,” Professor Desai said.
“We’ll work vigorously and collaboratively with regulators and other stakeholders to deliver the message that all skin tones deserve care, respect and celebration.”
He said the group’s activities would include developing educational resources, engaging with schools and universities, supporting community outreach, and producing clinical guidance to help dermatologists discuss the issue with patients in a culturally sensitive way.
Professor Rashmi Sarkar, president of the Pigmentary Disorders Society and an ILDS board member, said skin bleaching was far more than a dermatological issue.
“Skin bleaching has become a significant public health concern, driven by social perceptions that link skin colour with identity and beauty,” she said.
“A collective response from dermatologists, governments, educators, industry, and the media is urgently needed to challenge colour-based beauty ideals and raise awareness of the serious health risks associated with skin bleaching.”
ILDS president Professor Henry Lim said the initiative built on the organisation’s broader efforts to position skin health as a global health priority.
“The establishment of the ILDS Strategic Working Group on Skin Bleaching is the next step in our long-term campaign to drive meaningful change in perceptions of what healthy skin looks like and to ensure that everyone values the skin they live in,” he said,
The ILDS hopes its campaign will help shift the conversation from cosmetic skin lightening towards evidence-based management of pigmentary disorders while reinforcing a broader public health message: healthy skin comes in every shade.
Professor Shumack said the central message was deliberately simple.
“The best skin tone is the one that you are born with,” he said.
He said Australia’s increasingly multicultural population meant more GPs were likely to encounter more patients using imported skin-lightening products.
“The more multicultural we become, the more the skin bleaching issue becomes a potential problem,” Professor Shumack said.
For general practitioners, recognising the presentation is the critical first step. Patients may present with unexplained facial rashes, thinning skin, acneiform eruptions, rosacea-like changes, or unusual grey-blue pigmentation.
“The key for GPs is to recognise that this is an issue,” Professor Shumack said.
He recommended clinicians ask patients what products they are using, although identifying ingredients could be difficult because many imported preparations are poorly labelled.
Stopping treatment was often complicated by rebound reactions caused by potent topical steroids.
“If you stop them, then that rash gets dramatically worse,” Professor Shumack said.
“You’ve got this catch-22 situation where the patient says, ‘I can’t stop it because if I stop it, it gets worse.'”
Patients experiencing steroid withdrawal should be referred to a dermatologist, he said, as management often requires prolonged support with oral tetracyclines and gradual tapering using weaker topical corticosteroids.
Importantly, Professor Shumack stressed that skin-lightening agents themselves were not inherently inappropriate when used under medical supervision.
“There is a place for them,” he said. “When used properly, the correct concentration for a relatively limited period of time and in conjunction with sunscreens and sun protection, they’re quite good treatments for things like melasma.”
They may also be useful for treating post-inflammatory hyperpigmentation and, in selected specialist settings, extensive vitiligo.
“The weaker products are available over the counter with appropriate instructions, which are quite appropriate in Australia,” Professor Shumack said.
“The slightly stronger ones are usually provided on the basis of a script.”
He said the concern was not medically supervised treatment of pigment disorders, but the unsupervised pursuit of lighter skin using potent, unregulated products.
As awareness grows internationally, he said Australian primary care clinicians had an important role in recognising complications early and helping patients safely discontinue harmful products before permanent damage occurred.
