Skin Lightening as An Image Enhancing Phenomenon: Investigating Risks, Motivations, and Underlying Psychological Factors

Background: Skin lightening phenomenon is a widely growing trend with serious side effects. Its history spans many decades and affects different cultures and regions globally. So far it has been marginally investigated and the full extent of its reasoning and motives are still poorly understood. Aim: to enhance the existing knowledge and increase public and professional awareness about this phenomenon through identifying the most at risk, exploring the underlying motivations, and analysing users’ experiences amongst multicultural populations in clinical and non-clinical settings. Methods: a mixed method approach was developed and comprised in four interconnected studies. Study one involved a comprehensive literature review which laid out the foundation for the following studies. Study two was a quantitative cross-sectional investigation based on semi-structured questionnaire distributed among 500 participants in clinical and non-clinical settings. Data were analysed using SPSS software where descriptive statistics and binary logistic regression were utilized. Study three was centered on semi-structured interviews with dermatological patients. The qualitative data obtained were analysed and coded using N Vivo software where themes and subthemes were generated. Study four focused on qualitative online data extracted from skin lightening related fora. Codes and themes were developed using N Vivo software. Results: Skin lightening use is considered as a mean to gain sociocultural benefits despite the well documented adverse effects. Colorism and prejudice against dark skin also helped fuel this practice. In addition, the role of online platforms in promoting “ideal beauty of fair skin” was a major factor driving skin lightening use. The results showed that Asian, females, 25 to 34 years old with medium coloured skin are the most likely group to use skin lightening products. Alarmingly, 51.8% of users reported side effects and 18.3% have purchased their skin lightening products online. The extracted motivational factors are sociocultural, skin conditions related, and psychological which are potentially integrated with each other. Accordingly, it was revealed that skin lightening users are more likely to have self-esteem issues. The online experience of skin lightening users emphasized the revealed motivations, side effects and ease of access to skin lightening products. Conclusion: The key issues that have been identified in this research reinforce the fact that skin lightening is a common and dangerous practice. This research identifies those most at risks and sheds new lights on the underlying risks factors associated with this behaviour in both clinical and non-clinical population. It provides some initial and unprecedented evidence to inform policy makers and regulators and help improve clinical practice in dermatology, psychology, and psychiatry. In addition, one of the goals of this research is to raise public awareness and tackle the dominance of harmful body image ideals