Monica G. doesn't dwell that much on her looks.
She is slender, and has long, dark hair and dark eyes, just like many other Indian women do.
She also shares something else in common with Indian women.
"If I have one hangup about my looks, it's my dark skin," said Monica, who lives in Salt Lake City. She didn't want to use her real name. "People tell me that I'm pretty, but I have dark skin."
She said that's something that drives many women into Indian-owned shops to buy skin whiteners.
"Mothers don't want their daughters or their daughters-in-law to be dark-skinned," she said. "Fair-skinned women are considered to be more beautiful."
Companies are taking advantage of this quest for lighter skin. For example, there's a Facebook application developed by Unilever, the manufacturers of Vaseline-brand products, that allows men to upload their photos and see what their faces would look like if their skin were lightened. It's part of a marketing campaign for their line of products especially for men.
"Much like self-tanning products in North America and Europe, skin lightening products are culturally relevant in India. In India, men use these products to lighten and even out their skin natural skin tone and to reduce the appearance of spots while protecting their skin from the sun," Unilever wrote in an e-mail. Unilever also makes a product called "Fair and Lovely," a skin lightener sold and marketed in India.
But Indian men and women are not alone in their quest for lighter skin. Global Industry Analysts, a research firm, predicts that the worldwide market for skin lighteners will surpass the $2 billion mark in the Asia-Pacific region by 2012. East Asians are among the biggest consumers of skin lighteners -- a survey by Synovate, a market research firm, found that 4 out of 10 women in several Asian countries use skin whiteners.
And even in Mexico, the skin lighteners abound -- a trend that suggests lighter skin may be an obsession among some groups in North America as well.
Whiter, But at a Price
Many skin whitening products available on the market contain mercury, which is effective at whitening the skin, but can be dangerous.
The organic mercury in these creams can be absorbed into the blood and cause damage to the kidneys and the central nervous system. It can also cross into breast milk and into the placenta, potentially harming unborn children.
The symptoms can include skin irritation, depression and others that are so common people may not even know they're sick, said Dr. Mark Abdelmalek, assistant professor of dermatology at Drexel University College of Medicine.
Back in May, the health departments of Virginia and California issued alerts after several people in each state showed signs of mercury poisoning from using face lightening creams imported from Mexico.
The California Department of Health said members of one family became ill after using a cream with a very high level of mercury. The department said one of the women used an unlabeled, non-prescription face cream produced by a layperson that was brought into the U.S.
Other family members in Virginia used cream made by the same person and also became ill, prompting the department of health to issue an alert.
The U.S. Food and Drug Administration banned the use of mercury in skin lightening products in 1990. In April, Cambodia banned the import and sale of a particular Vietnamese skin-whitening cream linked to the death of a 23-year-old woman. Thailand also banned dozens of skin whiteners containing mercury. But mercury is still a common ingredient in products made in other countries.
"We have more testing and oversight than other countries do," said Drexel's Abdelmalek.
He said a number of patients have brought him products from other countries, and asked him to prescribe something just like it.
"A lot of times there were no labels or the labels were in a foreign language, and I really didn't know what the product was. It probably wasn't very safe to use," he said.
He said there are safer options, such as hydroquinone, azelaic acid, lasers and resurfacing procedures.
"But before those, use the one that's the safest -- sunblock," he said.
Experts also recommend avoiding products with no labels and making sure there's no mercury in the products.
Cultural Beliefs Trump Safety Concerns
Ads for products like "Fair and Lovely" touch on the belief held in some cultures that people with lighter skin are considered more attractive and get better jobs, make more money and are viewed as being of a higher class. In one "Fair and Lovely" ad on YouTube, a woman landed her dream job as a television journalist only after she lightened her skin.
"It has to do with how whiteness in some cultures is associated with leisure time, meaning people with lighter skin don't have to spend time working out in the sun," said Matthew Hughey, assistant professor of sociology at Mississippi State University. "In some cultures, lighter skin means having higher status."
He understands that there are cultural factors that drive people of different cultures to want to change their skin color. There are also pigment disorders, such as melasma, which is a discoloration of the skin that often occurs during pregnancy, that make people want to change their skin color.
"But doctors would probably advise against changing your natural skin color," he said.
Despite the risks and judging by the rapidly growing market for skin lighteners, many people are either unaware of the risks mercury poses or willing to use them anyway.
"People think it's worth the risk, and that having light skin will bring them more status and more opportunities," said Hughey.