In a market saturated with promises of a brighter, fairer and flawless skin Dr. Nishantha Pathirana, Consultant in Dermatology, Army hospital is calling for caution, awareness and a serious rethink of beauty standards. With decades of experience in dermatology and aesthetic medicine, he spoke to the ‘Sunday Island’ about the risks, myths surrounding fairness creams in Sri Lanka. “We see many patients suffering from thinning skin pigmentation disorders, sensitivity and even acne, all triggered by these whitening creams. His message is simple, understand your skin, protect it from the sun, hydrate well, eat smart and consult a qualified dermatologist before trying out any treatment.

In the age of skin positivity and inclusive beauty, the fairness cream industry thrives. Walk into any beauty aisle or scroll through online skin care ads, and you’ll still find rows of creams, serums and soaps from night creams to face washes and even sunscreens promising instant fairness, shelves are filled with products that prey on security. What’s driving this persisting obsession?

Today, there is a belief that being lighter gives you a better chance-whether in love, in the job market or simply in being accepted says Dr. Nishantha Pathirana

Doctor warns people should understand that most of these creams contain harmful ingredients, like steroids, mercury or others which are harmful to the skin. Long term use can lead to permanent skin damage, or pigmentation issues.

Q: Why do Sri Lankans prefer fair skin?

The preference for fair skin in Sri Lanka — as in many South Asian societies — is shaped by a combination of historical, cultural, social, and economic factors. Here’s a breakdown of why this bias exists:

Colonial Legacy

Sri Lanka was colonized by the Portuguese, Dutch, and British over several centuries. During colonial rule, lighter skin was associated with power, privilege, and superiority.

This established a hierarchy where Europeans (with fair skin) were at the top and locals (often darker-skinned) were seen as lower status. That legacy lingers in perceptions of beauty and status.

Cultural and Religious Influence

In ancient South Asian literature and folklore, fair skin was often idealized. For instance, many gods and heroes in Hindu and Buddhist stories are described as being radiant or light-skinned.

The idea of beauty being linked to purity or divinity often included a preference for lighter tones.

Class and Caste Associations

Historically, upper castes or higher social classes were often less exposed to the sun due to indoor lifestyles, resulting in lighter skin.

Darker skin came to be (unfairly) associated with manual labor, poverty, or lower status. These associations still persist subtly in social attitudes.

Media and Advertising

In Sri Lankan media, like much of South Asia, has long promoted lighter-skinned models and actors, reinforcing the idea that fair skin is more attractive or desirable.

Fairness creams and skin-lightening products are heavily marketed, often using slogans that link fair skin to success, confidence, and romantic desirability.

Global Beauty Standards

Western beauty standards, often emphasizing lighter skin, have been globalized. Through movies, fashion, and social media, these ideals influence local preferences.

However, this is beginning to change with more global awareness around colorism and representation.

Marriage and Social Expectations

In traditional matchmaking (including arranged marriages), families often prefer fair-skinned brides and grooms. Matrimonial ads still frequently list “fair” as a desirable quality.

This puts pressure, especially on women, to conform to lighter-skinned ideals.

Q: Do you see this reflected in your patients?

Yes, at least 25% of my patients ask for a fairer skin

What is the medical news on fairness creams and skin bleaching products?

Here’s what’s new in fairness creams and skin-bleaching products — including health risks, recent studies, and regulation updates:

Health Risks — Particularly in South Asia

Steroid Contamination and self-prescribing

In Lucknow, India, dermatologists report a surge in skin damage—as many as 80% of patients with pigmentation or fairness concerns had used over-the-counter creams promoted by social media before seeking help. These often contain steroids, leading to fungal infections, skin thinning, rashes, and lasting scars.

Mercury Toxicity and Kidney Damage

A major study in Bangladesh found that 22 out of 26 skin lightening creams exceeded the safe mercury limit

In Sri Lanka, dermatologists report a notable increase in kidney disease linked to these creams—sometimes outpacing cancer. Symptoms include stretch marks, discoloration of nails and palms—occurring even before long term effects like cancer manifest .

Indian researchers from Kerala also documented cases of nephrotic syndrome (membranous nephropathy) tied to fairness cream use: heavy metals, particularly mercury levels up to 10,000× above safe levels, were found in blood and urine samples. 68% of cases in one cohort involved skin cream use.

Other Harmful Ingredients

These products often contain other risky agents: hydroquinone, corticosteroids, and kojic acid. Long-term use can cause skin ochronosis (dark patches), glaucoma, hypertension, immune suppression, and increased skin infections.

Q: What are the short-term and long term risks using fairness creams?

Fairness creams (also known as skin-lightening or skin-brightening creams) often promise lighter, more even-toned skin. However, many of these products—especially unregulated or over-the-counter ones—can pose serious short-term and long-term health risks, depending on their ingredients and usage patterns.

Common Active Ingredients in Fairness Creams:

Hydroquinone, Mercury compounds, Corticosteroids (like betamethasone, clobetasol), Arbutin, Kojic acid

Niacinamide (generally safe, but often combined with harsher agents)

Short-Term Risks

These often appear within weeks to months of regular use:

Skin Irritation

Redness, itching, burning sensation

Especially with hydroquinone or kojic acid

Allergic Reactions

Rash, swelling, contact dermatitis, caused by fragrances or harsh chemicals

Photosensitivity

Increased risk of sunburn due to skin thinning, Common with hydroquinone or corticosteroids

Steroid Acne

Corticosteroids in creams can cause acne breakouts

Temporary Skin Lightening

Uneven results, “patchy” depigmentation

Long-Term Risks

These develop with prolonged or heavy use, especially of unregulated products:

Skin Thinning (Atrophy), Fragile, easily bruised skin—common with long-term steroid use

Ochronosis

Paradoxical darkening of the skin with prolonged hydroquinone use

Mercury Poisoning

Found in some illegal creams, Symptoms: mood changes, kidney damage, tremors, memory issues

Hormonal Imbalance

From corticosteroids absorbed through the skin, can lead to weight gain, menstrual irregularities, or cushing’s syndrome

Increased Risk of Skin Infections

Due to immune suppression from steroids

Psychological Dependence

Body image issues or addiction to skin lightening

Dr. Nishantha Pathirana

Skin cancers

Q: How often do you treat patients suffering from damage caused by these products?

This is so frequent at least I do see 5-6 cases a day after using various whitening agents.

Some fairness creams are marketed as herbal or natural. Are they safe?

Fairness creams that are marketed as herbal or natural may seem safer, but “natural” doesn’t always mean safe or effective. Here are some important considerations:

What “Herbal” or “Natural” Might Really Mean

These terms are not strictly regulated in many countries, so a product labeled “herbal” might still contain synthetic chemicals, preservatives, or steroids.

Even genuine natural ingredients can cause side effects or allergic reactions, especially on sensitive skin.

Potential Risks of Herbal Fairness Creams

Undisclosed Steroids or Mercury:

Some so-called natural creams have been found to contain harmful steroids or mercury, which can cause skin thinning, acne, or long-term pigmentation issues.

Mercury, in particular, can cause kidney damage and neurological problems with prolonged use.

Photosensitivity:

Ingredients like citrus extracts or essential oils can make your skin more sensitive to sunlight, increasing the risk of sunburn or hyperpigmentation.

Lack of Efficacy:

Many herbal creams claim to “lighten” or “brighten” skin but often offer no real results beyond temporary moisturization or superficial effects.

Irritation or Allergic Reactions:

Natural ingredients like neem, sandalwood, or turmeric may cause rashes or dermatitis in some individuals.

Q: What is your take on Ayurvedic or home-made remedies? Are they effective or dangerous?

When it comes to ayurvedic and home remedies most of the ingredients are time tested and well known. When these things are used consistently one can see the improvement in skin colour but those are too not free of side effects since those too can cause above side effects.

Q: Are fairness injections and IV drips like glutathione safe and effective or are they medically approved?

Fairness injections and IV drips like glutathione are marketed for skin lightening or “brightening,” but their safety and effectiveness are controversial and depend on multiple factors.

Q: What Are fairness Injections?

These usually involve IV administration of glutathione, sometimes combined with vitamin C or other antioxidants, marketed to lighten skin by reducing melanin production.

Q: Do They Work?

Glutathione is a powerful antioxidant found naturally in the body. It can affect melanin production in lab settings, but:

Evidence for systemic (whole-body) skin lightening through IV glutathione is limited and inconsistent.

Some people may notice temporary lightening or “brightening” of their skin tone, but this is not guaranteed, and long-term effects are unclear.

The FDA (U.S.) and WHO do not approve glutathione IV for skin whitening due to insufficient evidence and safety concerns. In Sri Lanka too it has not been approved to be used for cosmetic purposes.

Safety Concerns

Unregulated use: Many clinics offer these drips without proper oversight or medical standards.

Dosage risks: High doses or frequent use may lead to kidney or liver damage, thyroid issues, or rare skin disorders (e.g., Stevens-Johnson syndrome).

Unknown interactions: Especially risky for those with pre-existing health issues or on medication.

IV risks: Any intravenous treatment has inherent risks — infection, phlebitis, and allergic reactions.

Q: Is Glutathione Safe?

Oral glutathione supplements or those obtained from diet (e.g., in fruits and veggies) are generally safe but less potent for skin effects.

Glutathione is used medically for certain conditions like chemotherapy side effects or liver detox, under supervision.

The bottom Line is that not recommended for cosmetic use unless prescribed and administered by a licensed medical professional.

Efficacy is unproven, and risks may outweigh benefits—especially in the absence of strong scientific backing.

The pursuit of skin lightening can also raise concerns around colourism and mental well-being. It’s worth reflecting on motivations and considering safer skincare alternatives (like sunscreen, hydration, and topical agents).

Q: What is your message for people keen to improve their complexion?

First and foremost the person should understand their skin type ( Your skin type, dry or normal, sensitive or non-sensitive)

Select the products carefully which suits their skin as per the skin type.

Self-medication must be avoided an should take the opinion/ advice from a qualified personnel at the earliest when some is having any skin irritations

Maintain hydration well. (avoid using artificial drinks and carbonated water)

Balanced diet and regular workouts to maintain optimum BMI

Take plenty of antioxidants

Use the sunscreen of more than 50 SPF regularly especially when someone is getting exposed to direct or indirect sunlight. People who are working on light based devices may use a tinted sunscreen to avoid harmful effects of the screen.