Cosmetic Skin Lightening Among Cameroonian Women: From a Social Trend to a Public Health Issue

The relics of centuries of slavery and colonialism persist in black Africa, and one of the most eloquent illustrations of this phenomenon is intentional skin lightening using cosmetic products. Driven by a highly westernized view of beauty canons disseminated by traditional media and even more by social media, women, in most cases, indulge in the uncontrolled use of various skin-bleaching substances to whiten their skin [1].

Cosmetic skin lightening (CSL) is a widespread practice in Sub-Saharan Africa (SSA), according to various studies. Even though it varies from one country to another and from one locality to another within a country, it concerns between 20% and 77.3% of the population in SSA and is predominant among women of various ages, from adolescents to elderly women [2,3].

A similar trend is observed in Cameroon, where the prevalence of skin lightening ranges from  26.33% to 43.6%, according to a few published studies, gaining an ever-increasing number of adepts [3,4]. Skin bleaching can have serious short- to long-term consequences on the health of its practitioners, from benign skin problems such as irritations or pigmentation disorders to serious acute or chronic pathologies including kidney disorders, Cushing’s syndrome, and skin cancer  [456].

This phenomenon needs to be analyzed and addressed from a public health perspective to avoid worsening the progression of preventable diseases that would add to the burden of both infectious and non-communicable diseases in Cameroon. However, skin bleaching is not yet properly addressed and given due attention by the Cameroonian Government and health authorities [5,7].

This paper presents an overview of the CSL phenomenon among women in Cameroon and proposes policies that can contribute to mitigating its health-related consequences.

 

What is Cosmetic Skin Lightening?

Cosmetic skin lightening can be defined as all the practices leading to cosmetic depigmentation of the skin. It is a process whereby a person, on his or her own initiative, endeavors to reduce or eliminate the skin’s natural coloring by the use of cosmetic bleaching agents [3,7]. In Cameroon, the practice, often referred to as “Ndjansang,” involves the utilization of a wide range of handmade or industrial skin-lightening preparations for external use or internally administered [3,4].

While low to middle-class women opt for various whitening creams, gels, and lotions, more financially secure women may choose injections and pills of whitening substances with almost immediate effects [8].

Social Drivers of CSL in Cameroon

CSL is a complex multi-component phenomenon, and women who indulge in it can be considered both actors and victims of a system that sustains and even promotes this practice [7]. Cameroonian post-colonial society, like many others in SSA, is still affected by dysfunctional constructs left over from the slavery and colonization periods and fostered by Neo-colonialism [1,2]. This includes the progressive institution of the white or light-skinned woman as the ideal of feminine beauty [1,7].

Representations of this near-veneration of light-skinned women are pervasive and are displayed on advertising billboards, TV, social media, and above all, in the collective consciousness [1,7]. Women are thus subjected to a social dictate of what their skin color should look like and adopt CSL as an attempt to gain validation from men, other women, and society [1,7,8].

Moreover, CSL products represent about 10% of the total cosmetic market globally, which corresponds to about 1310 billion francs CFA [4]. It is thus a flourishing and lucrative market whose promoters – manufacturers, distributors, sellers, advertisers, and media – benefit from government inaction to promote fair skin as a model of beauty and social achievement [5,7]. This creates an environment that triggers a wave of women of all ages towards skin-bleaching products.

Determinants of Skin Lightening Among Cameroonian Women

Among the main motivations to CSL, Cameroonian women report conformism to the societal standard of beauty, the influence of relatives and friends, the desire to be more attractive to men, discrimination of women with darker skin tone, the desire for a uniform skin tone and tentative to treat skin problems like acne or scars [3,5,7]. From the experts’ perspective, CSL is also determined by misconceptions and misbeliefs related to the notions of self-perception, body image, race, identity, and mental health-related issues [4,7,8].

Skin Lightening-Related Health Issues

CSL relies on the utilization of chemical substances from natural or synthetic origin and often pharmaceutical products diverted from their medical use [7]. Active whitening substances on the Cameroonian market include hydroquinone, fruit acids (AHA), dermo corticoids, glutathione, mercury derivatives, and kojic acid [7,9,10]. The type and severity of CSL health complications depend on the nature, concentration, duration of use, interactions with other substances, and other factors related to the user [6].

The most commonly observed consequences are skin affections such as irritation, eczema, acne, scab, irreversible stretch marks, and skin infections [57,10]. But CSL can have deeper systemic complications, including Cushing’s syndrome, renal failure, hypertension, diabetes, skin cancer, and obstetrical and surgical complications [5,7].

Considering these complications, we cannot agree more with Zoung Kanyi (2019) that CSL is an emerging public health issue in Cameroon [4].

Challenges of Addressing Cosmetic Skin Lightening in Cameroon

The major challenge in addressing CSL in Cameroon is the absence of legislation. Unlike in other countries affected by this phenomenon, such as Senegal, there is no anti-depigmentation law in Cameroon [1,7]. Although a presidential decree (n° 2009/296 of September 17, 2009) establishing the operating procedures of the national standards and quality agency has been issued to regulate the cosmetic sector [7], a huge cacophony remains on the actions initiated by the different governmental bodies involved in the regulation. A recent controversy surrounding the release of  “lightening drinks” on the Cameroonian market illustrated this deplorable situation.

In addition, CSL products in Cameroon are available everywhere, from non-specialized stores to pharmacies, cosmetic shops, and esthetic saloons, and some users even go for homemade compositions [3]. This shows the prevailing anarchy in the sector and increases the complexity of effective regulation. Besides, women practicing CSL are often totally aware of health complications and usually adopt a defensive attitude towards sensitization actions [5,7].

Policy Recommendations

To the Cameroonian Government

  • Adopt a strict anti-depigmentation legislation
  • Improve regulating systems for the import, manufacture, and marketing of products intended for human consumption
  • Carry out joint actions involving the ministries of public health, trade, and the national standards and quality agency for scrupulous quality control of cosmetic products in the Cameroonian market
  • Support awareness-raising initiatives by individuals, NGOs, associations, corporations, etc.

To Stakeholders and Civil Society Organizations

  • Initiate actions involving social scientists, health professionals, and researchers to bring out evidence, inform and educate people about the dangers of CSL
  • Engage communities with communication for behavioral change
Solange Dabou
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Solange DABOU holds a Master of science in Clinical Biochemistry from the University of Dschang and have followed a distance learning training in epidemiology and health statistics from Aix Marseille University.

Dr. Bruna Djeunang Dongho
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Ghyslaine Bruna Djeunang Dongho, Ph. D., is the Senior Researcher in Global Health and Public Health at the Nkafu Policy Institute.

Regina Sinsai
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Regina Sinsai holds a Bachelor of Arts Degree in Psychology from the United States International University – Africa, in Nairobi and an HND in General Nursing from the Humanity Health Professional Training Center (HHPTC) in Yaoundé.

Evrard Kepgang
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Kepgang Evrard is a young research and humanitarian passionate. He holds a master’s degree in Public health and epidemiology at the University of Dschang.

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Dr Ronald Gobina is a Nephrologist, working with the Regional Hospital in Buea. He is a Health Fellow and the Director of the COVID-19 taskforce for the DLF foundation. He is member of the International Society of Nephrology (ISN) and the Initiative to Strengthen Health Research Capacity in Africa (ISHReCA).

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