The Price of Pale

Read This First

You don't have to stop to read this book.

That's the first thing to know. This book is for you if you use a lightening, "toning", "brightening" or "whitening" product right now, if you're about to start, or if you want to stop and don't know how. It is also for the parent who wonders what's in the jar on the bathroom shelf, and for the person who sells these products and has started to wonder too.

Most of what you've heard about skin lightening is one of two things: an advert promising glowing, even skin, or a lecture telling you to love the skin you were born with. Neither tells you what is actually in the cream, what it does to your kidneys, your nerves and your skin, or what to do when something goes wrong. This book does.

What this book is

• Straight information about ingredients. Mercury, strong steroids such as clobetasol, hydroquinone, glutathione and the newer "safe" actives: what each one does to your skin and the rest of your body, ranked honestly from common and annoying to rare and serious.
• A way to protect yourself whatever you decide. How to read a label, how to spot the products most likely to poison you, what supervised treatment of dark patches looks like, and which tests to ask for if you've used a product for a long time.
• No judgment. The pressure to be lighter is real, and it comes from families, partners, employers and adverts, not from vanity. We say so.

What this book is not

• It is not medical advice for you personally. It cannot examine your skin or read your blood tests. Use it to prepare for a conversation with a dermatologist, doctor or pharmacist, not to replace one.
• It is not a product guide. We never recommend a lightening brand, a mixing recipe, a strength to buy, or a drip or injection. Where products are named, they are named because a regulator or a published study named them.
• It is not a substitute for emergency care. If something on the Go Now card is happening to you or someone in your home, stop reading and get help.

About the stories

Every chapter opens with a person. Where we name a real case, it comes from a published medical report, a public health investigation or a regulator, and the source is cited. Where a story is a composite, the chapter says so. Some stories are composites; names and details are changed. No composite contains a real person's words, a named real clinic or a precise statistic.

Danger now?

Go to emergency care or call your local emergency number if you, or someone in your home, has any of these:

• Swelling of the face, ankles or legs with foamy urine, especially after months of using a cream
• Tremor, numbness or tingling, confusion or memory problems in someone who uses, or lives with someone who uses, a lightening cream
• A child in the home who is unusually irritable, not walking, sweating or unwell while someone uses a cream, or who has swallowed one
• Blistering, peeling skin, mouth sores or fever after a pill, drip or injection
• Face or throat swelling, wheezing or fainting during or after a drip or injection
• Fainting, vomiting, severe weakness or confusion after stopping a strong steroid cream used for a long time

How to read this book

You don't need to read it all at once. Chapters 1 and 2 first, because they explain why people lighten and why the products behave the way they do. After that, go where your situation is:

• I use a cream, soap or "mix" from a market, shop or online — Chapters 3, 4, 5 and 7
• I take glutathione pills or have had drips or injections — Chapter 6, then 7
• I'm pregnant, breastfeeding, or I have children at home — Chapter 8
• I want to keep going, as safely as possible — Chapters 7 and 9
• I want to stop, or my skin is already damaged — Chapters 4 and 10
• I'm tired of the pressure — Chapters 1 and 11

At the end of the book you'll find the Go Now card, a Product Check and Repair Plan you can take shopping and to a dermatologist, and a glossary of every medical word we use.

Before you start

Find the product you're using now. Get the box, the jar, the tube or the screenshot of the online listing. Look for an ingredient list. If there isn't one, or it's in a language you can't read, note that too. You'll need it in chapter 7, and by then you'll know exactly what to look for.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

Why People Lighten

In July 2019, a 47-year-old woman in Sacramento, California, went to her doctor because her arms felt wrong. They tingled and felt weak. Over the next two weeks her speech slurred, her vision blurred and she started to stumble. She was admitted to hospital, and there she got worse: confused, agitated, no longer herself.

It took two weeks in hospital before a blood test showed the answer. Her blood mercury was more than a thousand times the upper limit of normal.

Her family told public health investigators about a face cream. She had bought it in Mexico and had put it on her face twice a day for seven years. The laboratory found 12,000 parts per million of mercury in it, in a form called methylmercury that attacks the brain. The report in the US government's weekly journal of disease, MMWR, ends with a sentence that is hard to read: despite prolonged treatment to pull the mercury out of her body, she "remains unable to verbalize or care for herself, requiring ongoing tube feeding".

She was not trying to hurt herself. She was doing what millions of people do every night in front of a bathroom mirror: rubbing in something that promised clearer, brighter, lighter skin. Here is what she did not know. The cream was effective, and the reason it was effective was the poison in it.

Her case is the worst kind on record, not the typical one. The investigators called it the first known case of a lightening cream contaminated with methylmercury. Most people who use mercury creams do not end up in hospital. But many end up with damaged kidneys, damaged nerves or poisoned children, and most of them never knew there was mercury in the jar. That is what this book is for.

Sound familiar?

• You've bought a cream because a friend's skin "came out" fast on it, and you didn't ask what was in it.
• You've used a product with no ingredient list, or with a list in a language you can't read.
• You've mixed two or three creams together because one on its own was too slow.
• You've kept going after your skin started stinging, peeling or going thin, because the colour was finally changing.
• You've stopped, watched the dark come back darker, and started again.
• Someone at a wedding, an interview or a family lunch has commented on your colour, and you went home and ordered more.