Graduating with a master's degree in science, 23 year-old Nasim Jamil is an attractive young Pakistani lady, but unhappy with her looks. "I am not fair enough," she told IRIN. "White is best," she maintained.
Such comments are not uncommon in this Asian country, where skin colour is increasingly being promoted to reflect one's position in society, a phenomenon which has serious implications. Today Jamil is receiving counselling in the Pakistani capital, Islamabad, to improve her self-esteem.
"When you ask Pakistani ladies what their idea of an ideal woman is, they will tell you that she should have fair skin," Fozia Yasmin, a clinical psychologist with the Pakistani nongovernmental organisation Rozan, told IRIN. Some 50 percent of women that she had counselled had been concerned about their skin colour, she added. Employing three psychologists, Rozan offers workshops on building self-esteem in colleges, and counselling for women.
"You see advertisements for skin creams everywhere you go in this country," she explained, saying that women in this Islamic nation were expected to look their best at all times, but were at the same time expected to be subservient. She used the example of a television advertisement in which a well-known Pakistani actress is promoting a skin bleaching cream. "Women admire these beauties, and they want to look like them, so they will buy the product," Yasmin said.
Skin colour also determines social status, according to the clinical psychologist, who said it was acceptable to be darker skinned if you were a member of the lower classes, but not if you were part of the upper strata in Pakistan. Yasmin added that she had often overheard conversations in which older women encouraged girls to use bleaching creams, telling them that it would improve their chances of finding a wealthier husband. "Men in this country are also to blame, as they look for a marriage partner who is light skinned," she stressed.
However, the psychological aspect is not the only component of skin bleaching: doctors also warn of physical damage. "We have between 10 and 15 female patients per month who are treated for skin burns caused by these bleaching creams," a skin specialist at the state-run Pakistan Institute for Medical Sciences in Islamabad, Dr Naureen Zaheer, told IRIN.
Some women also use steroids to whiten their skin. Zaheer described this as a "lethal combination". "They have a very bad effect on the skin and make it thinner and more prone to disorders. It can cause acne, and could also have the reverse effect and turn the skin black," she warned. "The tissue becomes very delicate and can be damaged even if it is scratched."
The two main bleaching agents in the creams are ammonia and hydrogen peroxide. The ammonia can cause irritation and, according to skin specialists, this is what causes most of the reactions. Mild irritation results in redness. If it becomes worse, the skin can blister and burn. "The burn is usually superficial, but it can go deeper if you leave the cream on for too long," Zaheer said.
The dermatologist cited an example of a patient whose skin was ulcerated and prone to eczema, resulting in the face being covered in marks and blacks spots. "There have been patients whom I have referred to the plastic surgery department because the burns are so bad," she said.
Asked what advice she would give women to encourage them not to use the creams, she replied: "We know that women will use these creams regardless of the advice we give them. But what we do say is that they should not use them when consuming other medication."
Skin-whitening lotions contain chemicals, and are usually derivatives of a substance called phenol and must be used in conjunction with a sun block. Paradoxically, however, they can cause the skin to darken. "I have seen many allergic reactions to this bleach, Dr Rehana Jamil, a skin specialist at Islamabad's Ali Medical Centre, told IRIN. "If your skin does turn black you must stop using it straight away and it will eventually return to its normal colour."
Jamil cited many cases of women suffering second-degree burns to the face. In one incident, a woman treated by Jamil was in excruciating pain due to blisters on her face. Following treatment, the patient's skin settled, but she returned soon after with black patches on her face. "This was the post-inflammatory affect of the pigmentation, and was very difficult to treat. It took years to heal," she added.
The skin specialist warned that excessive use of the cream could also scar for life. "You see, ammonia is corrosive, and if it goes deep enough it can burn very badly, because it eats away the skin," she said.
As the most popular beauty treatment in Pakistan, salons and chemist shops cash in on the skin-lightening craze. "We sell more than 100 tubes of skin and facial hair bleach a week," a sales assistant at Islamabad's biggest pharmacy told IRIN. "These are the most sought-after products."
"About 90 percent of my clients ask for facial hair bleach or skin bleach, but I only offer it to those who are suited to it," the owner of the Zaib beauty salon in Islamabad, Naz Anjum, told IRIN. "I always do a skin test and advise my clients to do a skin test if they are using it at home, and it should only be used once every six weeks," she added.
At the Zaib beauty salon, skin bleach is used for treating scars and for lightening pigmentation. Anjum warned that problems occurred when the solution was not mixed properly, and too much ammonia was used. She, too, told of skin-bleaching horror incidents. "A bride-to-be came to me on the eve of her wedding day. She had used this bleach, and her face had turned red and blotchy and then gone black," she said.
Every year the cosmetic industry makes millions of dollars from the sale of skin-bleaching products in Pakistan and India alone. According to Yasmin, the only way to stop women from using such creams, lotions and potions is to empower them. "We need to promote the natural look. Pakistani women need to feel more comfortable with the way they look without the make-up and without the bleach, and that can be achieved if they improve their self esteem," she stressed.