Sales of 14 Steroid based creams restricted by Health Ministry due to indiscriminate use as fairness creams, but the core issues remain unaddressed

Health Ministry of India has now banned over-the-counter sales of 14 topical preparations containing steroids and antibiotics without prescription, owing to their indiscriminate promotion and use as fairness creams, but the problem is far from being resolved.

The creams which have been banned are alclometasone, beclomethasone, desonide, desoximetasone, flucinonide, halobetasone, methylpredinsone, priedincarbte and triancinolon acetonide among others. From now onwards, the pharmacists caught selling such banned creams and ointments over-the-counter without prescription are liable to be punished by the drug controller.

However, several pertinent issues remain unaddressed notwithstanding this token ban on sales of OTC steroidal creams:

BAN IMPLEMENTATION & ENFORCEMENT ISSUES:

  • Despite the ban on over-the-counter sales of these steroid based creams, it is still not implemented and effectively enforced at the ground level as large majority of pharmacy stores in India continue to sell Schedule H Drug Medicines without any medical prescription.
  • Many companies continue to illegally promote sales and indiscriminate use of such dangerous creams by incentivising pharmacists and misguiding common people to maximize their sales and profits, irrespective of the harm caused to public health.
  • India’s pharmaceutical regulator has approved at least 18 different corticosteroids for topical skin use, ranging from mild to super-potent. These usually cost less than Rs 100 a tube.
  • General public is largely unaware of the meaning of Schedule H Drug, that these drugs and creams can cause serious and long-term side-effects, if taken without proper guidance of a doctor.
  • Furthermore, only around 35% of pharmacies have a legitimate pharmacist on staff, so there is often no one to counsel the buyer on appropriate dosage and use of the cream.

And the most serious underlying cause here is the blatant and unethical promotion by the MNCs & celebrities of fairness of the skin as a measure of the superiority, attractiveness, calibre, confidence levels & self-worth, as well as job and marriage prospects of the individual in our country, which has been going on for several decades without any controls being put in place by successive governments to check such misleading ads of ‘fairness’, ‘whitening’ & ‘skin-lightening’ creams.

“[Pharmacies] dispense them like boxes of cookies. The drug companies know this is a drug and it’s not supposed to be used to lighten constitutive skin. But they label them with suggestive names like Skin Bright, Skin Light, Skin Shine, Look Bright.” as per Dr Shyamanta Barua, a dermatologist and honorary secretary general of the Indian Association of Dermatologists, Venereologists & Leprologists (as quoted in mosaicscience.com).

MAIN REASON FOR FAIR VS. DARK SKIN COMPLEXION:

Most skin-lightening treatments target the skin’s ability to produce pigment, or melanin, which gives the skin, hair and eyes their colour. Everyone has about the same number of cells to make melanin, but how much a person actually produce is down to their genes. Darker-skinned people produce more. When exposed to the sun, the body produces more melanin to absorb harmful UV rays and protect skin cells from sun exposure. And having more natural melanin (as is the case in regions with abundant sunshine and hot weather round the year) also means that darker-skinned people tend to develop fewer wrinkles over time and are less at risk of skin cancer with increasing age.

QUESTIONABLE INGREDIENTS IN FAIRNESS CREAMS:

“Some advertised creams are utterly useless and are cheating consumers; some of them contain potent steroids and other harmful chemicals; some creams contain steroids but these are not listed among the ingredients,” says Koushik Lahiri, a Kolkata-based dermatologist and chairperson of the Task Force Against Topical Steroid Abuse. “This is illegal and calls for criminal lawsuits.”

It’s difficult to be sure what is in these fairness/ whitening/ skin-lightening products because the manufacturers often don’t fully disclose the ingredients. Some ingredients — such as petroleum jelly, vitamin E, vitamin B3 and fruit acids — are quite harmless. However, many skin-whitening creams contain chemicals that reduce the concentration of melanin (which gives the skin its dark pigmentation) but are harmful to the skin, including hydroquinone, mercury salts, chromium, hydrogen peroxide, magnesium peroxide or zinc peroxide,  kojic acid, and steroids, all of which can cause serious side effects:

  • As per WHO, Mercury compounds have been found to be used in skin lightening creams and soaps for many years to suppress the production of melanin, but its use has been linked to brain & kidney damage if it is absorbed by the skin and accumulates in the body. It can also cause nervous & gastrointestinal disorders, skin rashes and infections, mood swings, memory loss, and muscle weakness.

The CSE’s pollution monitoring lab PML, found mercury in 44 percent of the fairness creams it tested. “Mercury is not supposed to be present in cosmetic products (both those imported and manufactured here) as it is banned in India. Their mere presence in these products is completely illegal and unlawful,” CSE director general Sunita Narain said at the time.

The report also threw up another scary fact — even products that didn’t have the words “fair” or “whitening” in their branding had mercury. So, “light”, “anti-marks”, “glow” and “radiance” are to be watched out for.

  • Hydroquinone, another common potential carcinogenic and neurotoxin ingredient, can cause many side effects, including dermatitis (skin irritation), cataracts, blue-black skin discolouration (ochronosis), as well as damage connective tissue in the skin and cartilage, which could result in painful joint conditions. It can also cause offensive fish like odour in users.

In a 2016 paper, titled Women’s Disempowerment and the Market for Skin Whitening Products: Experimental Evidence from India, the researchers point to strong pharmaceutical products sold under the whitening umbrella. These contain bleaching agent and melanin production inhibitor hydroquinone, which is banned in Europe and Australia, because it is believed to be a carcinogen.

  • Many skin lightening creams also contain steroids in doses up to 1,000 times higher than in creams used to treat eczema and other skin conditions. Steroid use can cause all sorts of complications such as thinning of the skin, acne, red stretch marks and discolouration.
    • Worse still, the steroids in these creams can act like cortisol, a hormone made by the body to deal with stress. Too much cortisol can cause a myriad of problems, including swelling of the face and abdomen, weight gain, thin skin that bruises easily, stretch marks, weak muscles, high blood pressure, diabetes, osteoporosis and depression.
    • It can also fool the body into ceasing cortisol production. So, if someone suddenly stops using these creams, they could become seriously ill because their stress hormones have been temporarily “turned off”.
    • The creams must be used continuously to maintain the bleaching effect, otherwise the skin will re-pigment. Sometimes the skin can even become “addicted” to the creams (in the form of a withdrawal rash), making it very difficult to stop using them.
    • Worst of all, there are signs that improper steroid prescriptions – often in cocktails containing a mix of steroids, antibiotics and antifungals – is fuelling a surge in bugs resistant to normal treatments.

In 2011, a study published in the Indian Journal of Dermatology revealed that 60 percent of patients who had skin problems on their face were using self-prescribed steroid-based creams. The study named the condition as “topical steroid-dependent face.” “This is a silent epidemic of astronomical magnitude,” warned dermatologist Koushik Lahiri, who also spearheads a Facebook campaign, “No Steroids on Face.”

The creams of UB Fair, when tested in 2015, were  found to contain potent steroids including mometasone along with skin bleaching agents, whose long term use without medical supervision can cause issues including unwanted hair growth, pustular lesions, facial rashes, and fixed redness. Other topical steroids can cause skin thinning, rashes, excess facial hair growth if used for a long period.
 Other skin-lightening methods include a chemical peel, which removes the top layer of your skin. This leaves fresher skin exposed to harmful solar radiation and environmental pollutants. Laser treatments offer an even more aggressive approach by breaking up a skin’s pigmentation, sometimes with skin-damaging results. Also, there are chemicals such as glutathione in form of pills and injections (normally used for counteracting side effects of chemotherapy), which is assumed to whiten the skin colour by deactivating the enzyme tyrosinase, that helps produce melanin. However, as per regulatory authority warnings, repeated injections of this drug can lead to skin rashes, thyroid dysfunction, kidney failure and blood poisoning, and other fatal medical conditions.
 MNCs & CELEBRITIES ARE AGGRAVATING THE PROBLEM:

“We bring up girls to believe how they look is more important than who they are,” says Kavitha Emmanuel, the founder-director of Women of Worth, the Chennai-based NGO behind the “Dark is Beautiful” campaign. “Why can’t brands come up with products for all skin shades? Or promote healthy, glowing skin instead of fairness?”

Continuous bombardments of fairness creams ads by many MNC companies in electronic and print media over several decades has instilled this craving for fair skin deep in the pysche of Indian masses, by playing on their fear of inferiority complex of having brown skin, which stems from the centuries of rule of fair-skinned Britishers.

“The fairness creams marketing strategies, which show that a girl can’t get married unless she is fair, change the mindset of individuals. The visual media has changed the strategy so much that even fair people also use fairness products,” Ravi Mittal, managing director of SKEYNDOR India, a Spanish skincare brand, was quoted as saying to IANS in Business Standard.

Endorsement of these fairness creams by many leading  Bollywood Celebrities has further aggravated the already grave situation, as the common people are easily swayed and influenced by the celebrities glamorous image and dream world endorsements, even though their portrayal of blemish-less  and fair skin are mostly unrealistic and faked through use of excessive make-up, favorable lighting & camera angles, as well as generous photo-shopping and air-brushing of their images:

In 2014, the New Delhi based NGO Centre for Science and Environment (CSE), India, tested fairness creams and found large amounts of mercury, lead, nickel, & chromium in these creams, many of which were endorsed by some of India’s top actors.

Many leading Bollywood actors (both female and male) are guilty of actively promoting an unrealistic bias for fairness  in lieu of earning big sums of money (read several crores of rupees per year) from these MNCs without any consideration for the health and money of unsuspecting general public, and therefore, are or have been equally responsible for promoting such unethical stereotypes, including among others:

  1. Shah Rukh Khan – ‘Emami Fair & Handsome Cream’
  2. Hrithik Roshan – ‘Emami Fair & Handsome Cream’ 
  3. John Abraham – ‘Garnier Men PowerLight Fairness Moisturizer’ 
  4. Shahid Kapoor ‘Vaseline Men Antispot Whitening Face Cream’
  5. Arjun Rampal – ‘Nivea Men Advanced Whitening Face Wash’
  6. Saif Ali Khan‘Fair & Lovely Menz’
  7. Siddharta MalhotraFair & Lovely Menz’
  8. Varun Dhawan‘Fair & Lovely Menz’
  9. Pulkit Samrat‘UB Fair’ 
  10. Virat Kohli (Cricketer)‘Fair & Lovely Max Fairness Cream’
  11. Yuvraj Singh (Cricketer)‘Fair & Lovely Max Fairness Cream’
  12. Katrina Kaif – ‘Olay Natural White Fairness Cream’
  13. Deepika P. – ‘Garnier Fair Miracle & Neutrogena Fairness Cream’
  14. Aishwarya Rai‘L’Oreal White Perfect Cream’
  15. Sonam Kapoor‘L’Oreal White Perfect Cream’
  16. Yami Gautam – ‘Fair & Lovely Cream’
  17. Jacqueline Fernandez‘Skin White Cream’
  18. Ileana D’CruzPonds White Beauty Cream’
  19. Vidya Balan‘Dabur UVeda Complete Fairness Cream’ 
  20. Asin‘Fairever Fairness Cream’
  21. Preity Zinta‘Roomantra Fairness Cream’
  22. Isha Deol ‘Garnier LightMatte Fairness Cream’

As is clearly evident from the above examples, all these products being marketed by MNCs & endorsed by celebrities contain the words ‘fairness’, ‘whitening’,  ‘skin-lightening’ in their names & description. 

The beauty and healthcare group Emami launched the male equivalent, Fair & Handsome, in 2005. It is billed as “the world’s No 1 fairness cream” and, as the male market leader, achieved sales of USD 13 Mln in 2008. Shahrukh Khan, a Bollywood superstar, is its brand ambassador. “I share a long and fruitful association with the Emami Group and this is yet another step toward strengthening my faith in them and their products,” Khan had said on the Fair & Handsome website.

Big celebrities such as Shah Rukh Khan are not so naive that they don’t understand the kind of impact they have and the message that they are sending out to the masses by unabashedly and unashamedly promoting and endorsing these ‘Fairness’ Creams to public. Shah Rukh Khan has a family himself, and has a wife and daughter both with dusky complexion (not the so-called ‘Fair’ skin tone). So, would he call them ‘losers’ due to their complexion, and ask them to use these fairness creams (for women) to become successful in life? Unlikely. But he will still sell anything, as long as he keeps earning the mega bucks, as they have no conscience at all.

“The real tragedy is that people who are not fair suffer complexes, feel inferior, and are often discriminated against purely because of their skin tone. And yet, we glorify movie stars most of whom are multi-millionaires, who in endorsing these creams (all the while insisting that they only endorse products they believe in) perpetuate the myth further: that fair is beautiful.” Tarun Tahilani, an Indian fashion designer, was quoted as saying in ft.com.

Few Bollywood actors such as Abhay Deol & Nandita Das have taken a stand and rightly called out their racist biases and publicly shamed the culprits on online media (both the MNCs & the celebrities involved), NDTV has officially announced that they will not air any fairness cream ads on their channels (even at the expense of foregoing advertisement revenue) and a couple of these offenders have expressed regret over promoting such fairness products in the past (Priyanka Chopra, Dia Mirza, etc.), but such incidents of sanity and course-correction are few and far between, as all these product companies, most of the media and celebrities remain largely unapologetic about this issue, and even continue promoting them.

By and large, the fairness cream industry is thriving and both MNCs and celebrities endorsing them are happy minting money at the expense of the health and money of naive and gullible public, due to lack of any clear preventive regulations and government control.

MULTI-BILLION DOLLAR INDUSTRY & GROWING FAST:

Much of the problem seems to be the fact that loopholes in the law allow brands to acquire cosmetic licenses for products that should actually be classified as drugs. If one follows the World Health Organization’s definition of a drug which is “any substance or product that is used or intended to be used to modify or explore physiological systems or pathological states for the benefit of the recipient,” then Indian fairness products should really be classified as prescription drugs rather than cosmetic products. But drug licenses are harder to procure.

According to Mintel’s GMN report, in 2012, skin whiteners and lighteners made up the largest segment of the facial care market in India. It was worth INR 23.3 Bln (£ 233.2 Mln) and accounted for 46% of the retail facial care market.

In 2010, the country’s largest research agency AC Nielsen estimated that the Indian whitening cream market was expanding at a rate of nearly 18% a year.  In 2012, it was estimated that figure will rise to about 25% that year and the market would reach about USD 432 Mln (Rs. 2,600 crores). In 2012, Indians were supposed to have consumed 233 tonnes of skin-whitening products. ‘Fair & Lovely’ holds over 50% of the overall skin whitening market in India.

In 2014, the obsession with “whiteness” scaled a new level when a brand came up with a product “Clean & Dry” designed to “brighten” the vagina. Now, 6 years later in 2018, we are easily looking at a over billion dollar industry, even assuming a conservative growth rate of 18% based on AC Nielsen estimates and Mintel’s GMN report.

Dr. Susan Sridhar, the Dean of Media Studies at Hindustan College of Arts and Sciences, Chennai, is well aware of this phenomenon: “The obsession with fair skin is being called the ‘Snow White syndrome’ in India, a market where sales of whitening creams are far outstripping those of Coca-Cola and tea. One of the main reasons for high standards of beauty being imposed on young girls and women is pure economics.

A multi-billion dollar economy is built on our insecurities about the size, shape and colour of our bodies. The main idea is to make us feel insecure about ourselves and then sell a product that will assumedly make us almost perfect as the models we see on screen.”

Men’s fairness creams account for around Rs. 400 crore in sales of which ‘Emami Fair & Handsome Cream’ constitutes 40% sales, while ‘Fair & Lovely Menz’ and ‘Garnier Men PowerLight Moisturizer’ constitute ~10% each (according to research firm Euromonitor International), and is growing at a very fast pace every year.

REMEDIAL ACTIONS TAKEN SO FAR BUT ARE THEY ENOUGH?:
The Advertising Standards Council of India has attempted to address skin-based discrimination in 2014 by banning ads depicting people with darker skin as inferior, but the products are still marketed. Ads for skin-lightening creams still appear in newspapers, on television and on billboards, featuring Bollywood celebrities.
“Advertising should not communicate any discrimination as a result of skin color,” read the new ASCI guidelines, and the expression of the model in the ads should not be “negative in a way which is widely seen as unattractive, unhappy, depressed or concerned.” However, these guidelines have miserably failed to rein in the offenders, who continue to promote fair skin tone.

In a rare crackdown earlier in Sep 2015, the Maharashtra Food and Drug Administration – acting on the complaint of the association of Indian dermatologists – removed a particular brand of fairness creams from sale in the state. The doctors had complained to the federal drug controller the fairness products – ‘UB Fair’ for men and ‘No Scars’ cream for women by the Chandigarh-based Torque Pharma – were promoted as cosmetic creams but, in fact, contained potentially harmful steroids and should have been sold as prescription drugs.

In a paper in the Indian Journal of Clinical Practice, authors Monika Agarwal and Vandana Roy say skin lightening is “not only a psychological and social problem, but also a public health issue.” They argue that if fairness creams are promising to modify physiological actions in the body – by changing dark skin to fair – then they should be brought under the category of a drug license.

In recent times, owing to the constant activism of skin-specialists and social workers, the federal drug controller issued notices to state drug controllers conveying the concerns expressed by the dermatologists’ association, asking them to “keep a vigil and take appropriate action” against erring brands. In Hyderabad and Maharashtra, the drug controller has registered more than 100 cases against companies selling fairness products containing harmful chemicals.

URGENT REMEDIAL ACTIONS NEEDED IMMEDIATELY:

While the above are a few positive developments in an otherwise bleak situation, India needs to do much more to contain this public health issue that might become an emergency if this abuse is allowed to continue unregulated:

  1. Lawmakers need to take immediate action and strictly ban all cosmetic creams and products from having the words ‘fairness’, ‘whitening‘, or ‘lightening‘ anywhere in their names or description, as well as any suggestive visual images should be prohibited.
  2. All companies and celebrities should be legally banned from promoting or endorsing any such fairness cream advertisements in any print or electronic media. Members of India’s upper house have called for a ban on advertisements for fairness products.
  3. Continuous & strict monitoring of all cream brands (including those for pigmentation, even tone, etc.) and their ingredients should be carried out by the state and federal drug controllers to ensure that the ingredients are only used in permissible quantity.
  4.  Regular periodic and surprise checks should be done at all pharma stores to ensure that any prescription drugs or creams are not sold to users without proper medical prescription and bill.
  5. Strict action (substantial jail term) along with high monetary penalty and cancelling of licence in case of any breach of law should be imposed on the erring parties (companies, celebs, media, pharma stores, and even corrupt state drug controllers).
  6. Civil society activists and dermatologists need to come together to keep up the pressure on the government, brands, & celebs.
  7. And perhaps most importantly, people need to learn to be happy in their own skin, & treat all equally irrespective of the skin color.

As a paper titled Fairness Creams in the Indian Market: Issues to be Resolved, says: “Skin lightening is not only a psychological and social problem, but also a public health issue that needs to be addressed with targeted interventions aimed at changing perceptions and educating people.”

“Children grow up with these preconceived ideas of beauty, which are modeled by their peers and parents. A lot of parental monitoring, friendly chats with kids and advice is necessary so that this wrong notion of beauty and overemphasis on external appearances are curbed.”, says Dr.Sridhar to tackle the problem.

Sources:

  1. Article in Business Standard dated Apr 8, 2018. Click here
  2. Article in FT.com dated Feb 6, 2010. Click here
  3. Article in Gulfnews.com dated Apr 27, 2012. Click here
  4. Article in theweekendleader.com dated Jul 27, 2012. Click here
  5. Article in theconversation.com dated Sep 11, 2012. Click here
  6. Article in Business Standard dated Apr 16,2014. Click here
  7. Article in NewsX.com dated Aug 14, 2016. Click here
  8. Article in Business Standard dated Sep 9, 2015. Click here
  9. Article in Glammonitor.com dated Sep 17, 2015. Click here
  10. Article in Quartz India site qz.com dated Apr 24, 2017. Click here
  11. Article in se.fashionnetwork.com dated Apr 27, 2017. Click here
  12. Article in Hindu dated May 8, 2017. Click here
  13. Article in Hindustan Times dated May 23, 2017. Click here
  14. Article in Mosaicscience.com dated Aug 24, 2017. Click here
  15. Article in thedrum.com dated Sep 15, 2017. Click here

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