The Snow White Syndrome

While the term was coined in India, the obsession with white skin is very popular in Vietnam as well

“I have had patients, expat patients, who came to me to ask why they were seeing active ingredients for skin lightening in simple, everyday-use moisturizers. That’s how widespread it is in Vietnam,” says Dr. Mark Siefring, an internationally-certified skin cancer expert at Stamford Skin Center, regarding the widespread popularity of skin lightening products in Vietnam.

Though there are no official statistics, skin lightening has always been seen as the number one skincare concern for many men and women in Vietnam. Fair skin is the standard of beauty in Asia in general and Vietnam specifically. A flawless, porcelain-colored complexion is the Holy Grail that many Vietnamese are willing to go to lengths to obtain. A search for “trang da” (“white skin”) on Google yields 1.2 million results, not the most searched for word but still respectable (the most searched phrase in Vietnam in 2015 topped out at 1.7 million results). Skin tone changing products are so widespread and in demand that they are often given their own category along with other universal concerns such as aging or acne.

“This obsession over fair skin is a product of centuries of culture and social stratification,” claims Dr. Tom Cuong, one of the four leading dermatologists at Stamford Skin Center. “Vietnam is an agricultural country. Historically, laborers and farmers who work under the sun have dark skin whereas the richer classes who can afford to stay indoors have fairer skin. As a result, fair skin is seen as a sign of class and wealth. This cultural perception is carried over to our time where it is reinforced by female pop stars, with especially fair skin, setting the standards of beauty.”

On the whole, both Dr. Cuong and Dr. Siefring agree that this desire for lighter, uniformed colored skin is harmless and fairly ordinary in and of itself. However, chronic overuse of skin lightening cosmetics coupled with ignorance of their possible side effects can lead to disastrous results.

“There are four types of skin lightening or brightening products: doctor prescription, over the counter medicines, registered and lawfully regulated cosmetics and, lastly, everything else that doesn’t fall in the first three categories,” explains Dr. Cuong. “One to three is fairly benign. It’s the fourth category that is the problem one.”

This fourth category, explains Dr. Siefring, contains everything from homemade DIY skin lightening cream to bottled witches’ brew sold without registration or regulation with relevant public health authorities. Because no safety standards apply for this fourth category, unwanted results may range from being merely ineffective to being truly dangerous for the users. “It’s impossible for us to know what exactly people put into these fourth category products. However, there are two active ingredients that are very popular in skin whitening creams because of their potency and proven effectiveness: hydroquinone is the chief skin lightening agent used in prescription formulations, topical corticosteroids are used in a few prescription formulations that are combined with hydroquinone and a synthetic retinoid, tretinoin. After these there are many like kojic acid, salicylic acid, and a list of others. Topical corticosteroids are one of the most abused in the DIY, or off-label use in Vietnam.” After that Dr. Siefring says both have impressive track records in skin lightening, and both come with possible hefty side effects.

According to Dr. Siefring, hydroquinone is a chemical compound that can inhibit the production of melanin in human skin, thus stopping the darkening effect created by sun exposure. Because of its toxicity in higher concentrations, hydroquinone is a heavily regulated substance in America and outright banned in Europe – and the reason its concentration is limited to four percent in the US, and formulations banned in Europe has been the risk of, and small numbers of cases associated with Vitiligo, an autoimmune condition where pigment(melanin)-producing cells called melanocytes are attacked and disappear from small or even large patches of the skin, leading to a near complete absence of all pigment in the affected patches of skin, topical corticosteroid has not been associated with  Vitiligo, and would even be employed to combat the occurrence and/or spread of the process.The second active ingredient, corticosteroids, has ill-understood mechanics when it comes to its skin lightening effects. “In extreme cases, overuse of extremely potent topical corticosteroids may also cause the adrenal gland to shut down, potentially leading to fatal results,” claims Dr. Siefring.

Explaining why many consumers choose the fourth skin lightening product type when there are three safe alternatives, Dr. Cuong explains: “Improving the tone and quality of one’s skin requires time, patience and knowledge. It takes months for any appreciable results to show up. The best prescriptions that are both safe and effective also tend to be fairly pricy. Consumers, on the other hand, want immediate results on a budget.”

Dr. Cuong adds that the lack of laws regulating false advertising and lax control over drugs and chemicals serves to exacerbate this problem. “There’s no penalty for false advertising in Vietnam. People can put anything in a bottle; promise the heavens, and not actually have to take responsibility for their claims. To add to that, consumers are overwhelmed with information from dubious sources in this day and age.”

“If you truly want to improve the tone and quality of your skin and have the budget for it, we advise you seek the help of a certified dermatologist,” says Dr. Siefing. “One of the most effective and safe skin lightening pharmaceuticals, such as the Tri-Luma cream, while unfortunately not available in Vietnam, all require the supervision of a professional.”

“Failing that,” say both doctors, “then the easiest, most accessible and cheapest method to fair skin is to eat right, exercise, drink plenty of water and stay away from the sun.”

For more on our series on beauty, click here.

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