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.
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.