Skin-Bleaching: Poison, Beauty, Power, and the Politics of the Colour Line.
Dans cet article, je remets en question la pratique du blanchiment de la peau selon laquelle, a l'aide de produits chimiques excessivement dangereux, les femmes (ainsi que certains hommes), parviennent eclaircir leur peau. En me basant sur de la documentation provenant de revues medicales et dermatologiques, de publicites relevees de magazines de mode ou de sites web, et sur de la documentation importante sur le racisme, le genre et la representation, je tente de comprendre l'ampleur des repercussions sociales, politiques et culturelles de cette pratique destructrice.
The practice of skin-bleaching is the focus of this paper, a practice whereby women (and some men) use various chemical agents on their skin to achieve a lighter skin tone, or even to appear white if possible. Skin-bleaching, I argue, is linked to the ways in which whiteness historically has come to be viewed as the paradigm, the standard, the universal human body, while blackness is seen as deviant, degenerate and ugly. By presenting a variety of medical articles, I will show that the medical communities in the west and elsewhere have failed to intervene in the production and use of these highly poisonous chemicals. Western medical authorities consider skin-bleaching exclusively as a black problem and therefore give this destructive practice a low priority. I will also show that the enterprise of skin-bleaching is a big business which brings together members of the medical community, the pharmaceutical industry, the chemical industry into a global nexus of producers, distributors and dispensers of poisonous skin-bleaching chemicals for the purpose of making a profit. (1) Finally, I argue that skin-bleaching is a particular, albeit very destructive, attempt to gain respectability and social mobility within the white supremacist capitalist social and political order. Hence, everyone -- "white," "black," or "people of colour," -- is implicated and affected, often in complex ways, by the politics of whiteness. Consequently, I situate the practice of skin-bleaching in the social and political context of white supremacist culture, a cultural hegemony that is global, and whose dominating impact is felt world wide.
Race, Representation, and the Construction of the White Body
Throughout western colonial history, the white body has been represented by the dominant culture as the most virtuous and aesthetically most appealing, while the dark body has been represented as the least virtuous and aesthetically least appealing. Colonial representations of race construct both whiteness and blackness, and the concomitant sets of values, dispositions and attitudes associated with such discursively produced racial identities and racialized bodies. In this article, I combine works of critical scholars of race and representations with the medical literature in order to make sense of this destructive practice.
Skin-bleaching is a practice that leads to a great deal of pain and shame, and, in some cases, causes irreversible bodily damage to those who practise it. (2) Discussion of skin-bleaching must be situated within the wider sociocultural, sociopolitical and socioeconomic conditions within which it takes place. Consequently, I take a critical look at this issue from a cross-disciplinary perspective. Skin-bleaching as a practice indicates a desire to be white, or to be less dark-skinned. As bell hooks has succinctly pointed out, hating blackness is a clear manifestation of a white supremacist ethos (hooks, 1992, p. 9). Hence to fully understand the medical, economical, political and social implications of the social practice of skin-bleaching, it is necessary to question the racist culture within which racialized bodies are created, contained, exploited and silenced. Making this connection is central to the understanding of the social economy of skin-bleaching.
David Goldberg (1993) argues that the history, as well as current discourses, of western culture has been informed by racist views and ideas. These include attitudes and dispositions, norms and rules, linguistic, literary, and artistic expressions, architectural forms and media representations, practices and institutions, through all of which the social and political order has been continuously reconsolidated, and through which white supremacist social and political order has been constituted, normalized and sustained.
In his book, The Racial Contract, Charles Mills argues that at the level of philosophical superstructure, liberalism -- as modernity's definitive paradigm of self and society, morality and politics -- has played a foundational role in the process of normalizing and naturalizing white supremacist social order as a universal system of inclusion (Mills, 1997). In this way, western philosophical thought and scientific practices often codify, naturalize and normalize racist ideology as undisputed "scientific evidence" that corroborates the alleged inferiority of racialized subjects. In so doing, the western cultural discourse of racism constructs racialized subjects by encoding human differences in terms of rigid dichotomized significations, which in turn, are discursively mapped onto the colonized bodies of others, Western cultural tools such as films, photography, literature, philosophy, poetry and travel narrative have been designed to discursively produce authoritative knowledge on the basis of which racial di fferences and race-based exclusions are coordinated, organized, conducted and justified.
Constructing colonized people's culture and body images as pathological, backward and, in the final analysis, ugly has been central to the western culture of white supremacy. Anne McClintock succinctly argues that it was the dominating "scientific gaze" at the bodies of colonized subjects that provided western colonial scientists the impetus for the production of racist knowledge, a knowledge that was useful for the exercise of power over peoples considered by the west to be inferior races, and who were therefore fit for conquest, exploitation and domination (McClintock, 1995, pp. 121-122).
The western culture of scientific racism constructed, normalized and disseminated racialized knowledge through anthropology journals, medical journals and travel narratives. Western discourses of scientific racism and "commodity racism" continue to work together to reinforce the western culture of white supremacy and political imperialism. Commodity racism, according to McClintock (1995), means specifically Victorian forms of advertising, photography, and museum exhibitions which discursively converted the narrative of imperial progress into mass-produced commodity spectacles (McClintock, 1995, p. 209). In the history of western racist culture, whiteness has functioned simultaneously as a commodity spectacle central to the capitalist mode of material production, and as a category of exclusion by discursively marking those who cannot possess whiteness. In this context, as a capitalist commodity, whiteness can be possessed potentially by everybody with the right exchange value. On the other hand, as the organiz ing principle of European colonial conquest, whiteness must be denied to those who must be exploited, subjugated, and dominated, because they are not white.
An 1899 advertisement for Pears' Soap in McClure's Magazine (cf, McClintock, 1995) illustrates the symbolic connection and epistemic contradiction between whiteness as a commodity spectacle of capitalist production and as a central ideological precept around which the European imperial conquest of nonwhite cultures and peoples had been justified. (3)
The first step towards lightening The White Man's Burden is through teaching the virtues of cleanliness. PEARS' SOAP is a potent factor in brightening the dark corners of the earth as civilization advances, while amongst the cultured of all nations it holds the highest place -- it is the ideal toilet soap. (McClintock, 1995, p. 32)
Whiteness is consumed in order to shore up the white supremacist cultural, economic and political domination of nonwhite cultures, economies and modes of production. Any attempt to critique white supremacist racist culture must come to terms with the centrality of the commodity spectacle to the social and political order of both the historical, and current, white supremacist capitalist system.
White supremacist commodity racism, and material domination of nonwhite cultures and peoples are best exemplified by tourist brochures geared to mainly western tourists. These brochures, which in many cases are produced by countries in the southern hemisphere that are desperate for "hard" currency, overwhelmingly show pictures of white people enjoying themselves, served by nonwhite people. There are nonwhite people in the west who travel to the south and elsewhere for pleasure and business but one seldom sees them having a good time as the white tourists in these brochures seem to. Worse yet, in an effort to lure white tourists to their countries, many countries of the south include in their tourist advertisements and brochures familiar colonial tropes such as "primitive people" and "places," and nude or semi-nude images of women. This tourist pornography of "exotic" bodies of third world women for the consumption of western tourists represents a continuation of western commodity racism.
In addition to providing pleasure and amusement to the white middleclass, commodity racism, at the same time, buttresses the construction of white supremacist racial identity. The construction of a superior white racial identity, through the circulation of commodity spectacles, goes hand in hand with the construction of inferior nonwhite identities discursively ascribed by the dominant culture brokers and image makers onto the bodies of those excluded from the realm of whiteness. This double representational strategy expels blackness from the universalizing enterprise of whiteness.
Poisonous Chemistry and Racialized Medicine
In this section I take a critical look at the social and medical implications of the practice of skin-bleaching by which mainly women, but also some men, use various toxic chemical agents on the skin to make their skin tones lighter. My aim is to make a link between the historic as well as current discourse of white supremacy and the damaging effects of skin-bleaching suffered by those who have been and still are excluded from the material privilege and cultural respectability which whiteness accords. Even though, to the best of my knowledge, the subject has received very little critical attention, skin-bleaching is an emerging global phenomenon with potentially devastating implications for those who practice it. For this reason, it is pertinent to understand its political, medical and social implications.
For several years certain laboratories have been trying to produce a serum for "denegrification"; with all the earnestness in the world, laboratories have sterilized their test tubes, checked their scales, and embarked on researches that might make it possible for the miserable Negro to whiten himself and thus to throw off the burden of that corporeal malediction. (Fanon, 1967, p. 110)
American Negro women of the nineteenth century sometimes rubbed lye directly on their skin, and others applied harsh acidic products made for removing dirt and grime from floors and walls. There were also homemade concoctions of lemon juice, bleach, or urine to smear on the skin and arsenic wafers to swallow, all designed to "get the dark out." (Russell et al., 1992, PP. 49-500)
Skin-bleaching chemical agents applied to the skin arrest the synthesis of the skin pigment melanin. In many cases, complete destruction of the melanocytes (tissues located in the epidermis which are responsible for the synthesis of melanin), are the result. There are many products on the market which claim to have the power to make darker skin whiter, as well as to make "white" skin even whiter. In this work I address only three chemical agents which are currently used as skin-bleaching agents, mainly because I have gathered sufficient published literature which links these chemicals to permanent bodily damage to human beings who are exposed to these poisonous chemicals. These three poisonous chemicals are mercury, hydroquinone and corticosteroids.
(a) Mercury-Based Skin-Bleaching Agents
Mercury is a highly toxic substance. (4) Inorganic mercury salts such as calomel and ammoniated mercury chloride have been used in the past for the treatment of certain skin disorders, such as psoriasis. There are three forms of mercury: elemental mercury, organic mercury salts, inorganic mercury salts. The severity of mercury poisoning varies with the type of mercury involved and the route of mercury uptake by the body. (5) However, there are general characteristics associated with mercury poisoning, including a tight feeling of the chest, chills, diarrhea, metallic taste, nausea, vomiting, emotional instability, irritability, depression, forgetfulness, insomnia, muscular weakness, renal failure, and loss of teeth. (6) Mercury-based skin-bleaching creams, soaps and ointments contain mercury chloride or calomel (Hg2Cl2) and ammoniated mercury chloride which are inorganic salts that act as skin-bleaching agents by inhibiting the proper function of tyrosine, the protein responsible for the synthesis of melanin. (7) The manufacturing and distribution of mercury-based skin-bleaching chemicals is currently illegal in North America and Europe. However, they are readily available in shops serving many ethnic communities.
Historically, the linking of mercury poisoning to skin-bleaching agents dates back to 1922. Reading early published medical literature on mercury poisoning linked to skin bleaching makes it abundantly clear that race, gender and class relations were central to the practice. Consequently, race, class and gender-based biases framed the medical community's attitude toward addressing this destructive practice. In a 1922 article, William Goeckermann described his encounter with a woman teacher who had suffered from facial and neck skin discolouration after using skin-bleaching creams containing mercury. (8) Dr. Goeckermann tacitly alluded to the class, and perhaps race, implications of skin-bleaching by comparing the facial disfigurement sustained by this woman to "dirt marks" on the face of Mark Twain's fictional poor white boy, Tom Sawyer.
"Miss C.A., aged 45, a schoolteacher, who was first seen Dec. 27, 1920, complained chiefly of discoloration of the face and of insomnia. The skin of the eyelids, nasolabial folds and chin and the folds of the skin of the neck were a brownish-gray or slate color. At a distance of several feet, the discoloration reminded one strongly of the dirty neck and the face of a boy who has limited his ablutions to Tom Sawyer's minimum." (Goeckermann, p. 605)
From the beginning, skin-bleaching came to be understood by the western medical establishment as a problem pertaining to blacks and poor whites and those who wanted to "pass" as white. The western medical community's views with respect to the medical and social implications of skin-bleaching has changed very little since Goeckermann's 1922 piece on the issue. In 1999, an article published in the Medical Journal of Australia clearly demonstrates race and gender tensions that implicitly inform the racist manner by which western medical communities treat those who suffer from the results of skin-bleaching chemicals, the majority of whom are women and people of colour. In this piece, Smith et al. describes the medical condition of a 42-year-old woman who had suffered from a severe case of depression, anxiety and paranoid delusion. Upon proper examination, this team of physicians found out that she was suffering from chronic mercury poisoning. From their published report, it is clear that the woman was unwilling t o tell them the actual source of her illness, but they suspected skin-bleaching. In their description of the case, they represented her not just as an unwilling subject, but as untrustworthy as well. As a result, we are told that in order to get to the "real" source of her illness, these doctors had to resort to their superior diagnostic techniques which gave them control over her body.
A 42-year woman presented with symptoms of depression, anxiety and paranoid delusions. There were no visual or auditory hallucinations and, apart from mild tremor, neurological examination showed no abnormalities. In addition to having a dark olive complexion, she was noted to have blue-black pigmentation in a partifollicular distribution of the chin and glabella. She eventually admitted to the regular use of a depigmenting creams for the past 18 years. The active ingredient in the depigmenting preparation is mercuric ammonium chloride of 175mg/g. (9)
It seems from the perspective of these physicians, this woman's "dark olive complexion," her "paranoid delusion" and "depression and anxiety," have played equal roles in the process of constructing her "pathology." Constructing her as a racial other, her "dark olive complexion" is reinforced by the implicit suggestion that the patient was a liar: "she eventually admitted to the regular use of a depigmenting cream for the past 18 years." In this way, this woman's pain and suffering as well as the social, political, and economic implications of skin-bleaching were minimized. In 1996, the United States Environmental Protection Agency (EPA) published a paper urging the United States Department of Defense (DoD) to suspend the sale of mercury to the third world. According to the EPA, from 1989 to 1993, the United States Department of Defense had sold 2,350 metric tons (5.18 million lbs.) of mercury to the third world. Further, the EPA stated that the use of mercury in the third world included the production of skin -bleaching creams. (10)
In 1996, more then 400 Mexican-American women and men living in Arizona, California, New Mexico and Texas got mercury poisoning after using a skin-bleaching cream called Creme de Belleza-Manning made in Mexico and imported to the United States illegally. (11) Creme de Belleza-Manning contains roughly 15 percent by weight of mercury chloride or calomel.
(b) Topical Corticosteroids (TCs)
Topical corticosteroids, or TCs, are the fastest growing and least reported form of skin-bleaching agents. (12) TCs are hormones with a wide range of applications in dermatology. (13) In order to better appreciate the specific ways by which TCs came to be used as skin-bleaching agents, a brief summary of the histological structure of the human skin is necessary. The skin, or integument, forms a continuous external surface of the body, and in different regions of the body varies in thickness, colour and the presence of hair, glands and nails. Despite these variations, which reflect different functional demands, all types of human skins have the same basic structure. (14) The external surface of the skin consists of a keratinized squamous epithelium layer called the epidermis. The epidermis is supported and nourished by a thick layer of dense, fibro-elastic connective tissue called the dermis, which is highly vascular and contains many sensory receptors. The dermis is attached to underlying tissues by a layer o f loose connective tissue called the hypo-dermis or subcutaneous layer which contains variable amounts of fat or adipose tissue.
The skin serves four major functions for the body. First, it provides protection against ultraviolet light, and mechanical, chemical and thermal injuries. Second, skin is the largest sensory organ of the body and contains a variety of receptors for touch, pressure, pain and temperature. Third, skin is a major organ of thermoregulation. The presence of hair, adipose tissues and sweat glands constantly regulate the body's internal temperature. Fourth, skin is an important site where excess energy in the form of triglycerides is stored for later use, as well as being the site of vitamin D synthesis. (15) The skin is the specific site where carcinogenic chemicals take their effects. In the case of skin-bleaching, bodily damage cannot be detached from its wider social and political implications. As Fanon reminds us, in the context of white supremacist social and medical discourse, the skin has been the most powerful site of social identity and subjectivity.
TCs' biochemical efficacy depends on the capacity and the rate at which they penetrate the epidermal layer and into the underlying dermal and subcutaneous layers. (16) There are two ways to increase the uptake of TCs by the skin: increase lipophilicity (fat solubility), or add other agents to TCs soften the skin's outer most layer, the stratum corneum. (17) Both of these techniques are designed to decrease the skin's resistance to the penetration of TCs. While these techniques increase the bioavailabity of TCs inside the skin, they also lead to serious side effects such as the thinning of the epidermal, dermal and subcutaneous layers of the skin as well as the hypopigmentation (discolouration) of the affected area of the skin. If not carefully regulated, TCs can significantly increase epidermal, dermal and subcutaneous atrophy, and increase the likelihood of opportunistic infections as well as epidermal, dermal and subcutaneous fragility. (18)
Besides thinning the skin, TCs disrupt the production of melanin. (19) The combination of thinning and hypopigmentation give the affected area of the skin a "fair," or "translucent" appearance. It is the conformity to this particular notion of aesthetic "beauty" that women who bleach their skin with TCs are after. Promise to give customers "fair," "translucent" complexions are often found on the packages of skin-bleaching chemicals. Additionally, the image of the "fair," "pure," "translucent," woman is the hallmark of the western visual aesthetic representation of white femininity (Dyer, 1997). This white supremacist aesthetic standard is the one against which all other women must be measured and judged. It is also the standard against which women who bleach their skin often measure their own sense of feminine beauty.
A recent report in the Washington Post on the emerging phenomenon of skin-bleaching among mainly poor black women in Kingston, Jamaica, backs up my point. When the reporter asked a 17-year-year-old young black woman why she was willing to take serious health risks to make herself appear lighter, she answered, "When I walk on the streets you can hear people say, 'Hey, check out the brownin.' It is cool." (20) She added, "When you are lighter, people pay more attention to you; it makes you more important." In the same report, a 22-year-old black woman responded: "I want people to think I am more than a ghetto girl....I want to walk into dance halls and feel like a movie star, a white one." (21) It is clear that from the perspectives of these women, who stand to risk their health and cause themselves unspeakable pain, gaining a few shades of whiteness is worth all the pain and suffering they go through in the process.
The most common over-the-counter skin bleaching agent in the world, including North America and Europe, is hydroquinone. Hydroquinone is a chemical agent whose melanin inhibiting properties were discovered quite by accident in 1938, when 17 black workers in a tannery plant in Waukegan, Illinois, complained of discolouration of the hands and arms. (22) An internal investigation conducted by the plant authorities found out that the problem was caused by rubber gloves treated with monobenzyl ether of hydroquinone (HQ), a substance ironically designed to reinforce the gloves worn by the workers in order to prevent discolouration of the leather these workers were handling. (23)
The incident found its way into the local media. As a result, by 1955, hydroquinone was being mass-produced in the United States for the purpose of skin-bleaching. By 1961, hydroquinone found a lucrative market in apartheid South Africa. (24) Hydroquinone came to the attention of the western medical communities when in 1975 South African dermatologist G. H. Findlay and his colleagues published an article linking the use of hydroquinone-based skin-bleaching creams used by 35 South African black women to an irreversible skin condition called exogenous ochronosis. (25) Exogenous ochronosis is a localized, blue-black hyperpigmentation in the epidermis, dermis and subcutaneous layers of the skin that can be induced by a number of different chemicals, including hydroquinone. (26)
In the initial phase of skin-bleaching, hydroquinone, by inhibiting the production of melanin, makes the skin appear lighter. However, after 6 months or so of continuous use, hydroquinone chemical deposits penetrate the epidermal layer of the skin and accumulate in the dermal and the subcutaneous layers of the skin, causing irreversible damage to the connective, collagen, fibroblast and cartilage tissues. At this stage, the bleached area of the skin starts getting darker. In addition, the affected area appears as though sprayed with strong blue-black spots. These are complex deposits containing hydroquinone residues and damaged skin tissues. Upon proper clinical and histological examinations, the skin manifests the negative effects of chronic hydroquinone poisoning, such as dermal colloid degeneration, the formation of a glue-like substance, and colloid milium-hydroquinone complex polymers that result, in most cases, in a permanent skin atrophy. (27)
Hydroquinone: A Case Study
I am intrigued by the history of how hydroquinone came to be used as a skin-bleaching chemical agent, because it is one of the commodities which links two countries, albeit in different contexts, that were deeply implicated in the white supremacist social and political order: the United States of America, where the substance was first discovered, and South Africa, where it has received a great deal of medical attention, and was until recently a lucrative market as the number one producer of hydroquinone-based skin-bleaching chemicals in the African continent. Hydroquinone is not the first, nor will it be the last, skin-bleaching chemical agent on the market as long as the world continues to crave the commodity of whiteness. However, it is the first chemical agent in the modem era mass-produced to meet the global hunger for whiteness, and in the process, has made its producers very rich. (28)
As indicated earlier, in 1975, the first medical report linking hydroquinone-based skin-bleaching chemicals to irreversible skin damage, exogenous ochronosis, was published by G.H. Findlay in the British Journal of Dermatology. (29) By using Findlay's published medical report, members of the South African medical community, as well as lay people, put pressure on the pharmaceutical companies who were manufacturing and distributing hydroquinone. However, the apartheid regime refused to ban hydroquinone based skin-bleaching chemicals being sold and manufactured in South Africa; instead, it agreed to "better regulate" its manufacture and sales.
As a result of regulation, by 1980 the concentration of hydroquinone in skin-bleaching creams, soaps and ointments sold and or manufactured in South Africa had been reduced from an 8 percent to a 2 percent upper limit, though there was no medical evidence to indicate that 2 percent hydroquinone in skin-bleaching preparations would not cause skin damage. In addition, in a sort of perverse cynical gesture, the apartheid regime legislated that sunscreen protection be added to all skin-bleaching products manufactured and sold in South Africa with a minimum Sun Protection Factor 5. The addition of sunscreen was, supposedly, meant to minimize skin damage caused by hydroquinone poisoning. This is because it was suggested, without scientific evidence, that the damage to bleached skin is greater if exposed to the sun. (30) However, Findlay has shown that hydroquinone poisoning results not from exposure to sun but from accumulation of hydroquinone deposits inside the dermal and subcutaneous layers of the skin which lea ds to a permanent damage of the affected area of the skin. Under proper clinical tests, hydroquinone caused damage to the underlying tissues as well as to the epidermal layer, giving the appearance of patchy, sooty, coarse, brown, blue-back spots. (31) Taking a cue from the actions of the apartheid regime, medical authorities in Europe and North America followed suit and reduced the concentrations in over-the-counter hydroquinone skin-bleaching preparations to 2 percent. On the basis of the arbitrary decision made by one of the most racist regimes of the modem era, today you can buy 2 percent hydroquinone based skin-bleaching creams, soaps and ointments in almost all Canadian drug stores and "beauty" shops.
Six years after the concentration in over-the-counter hydroquinone skin-bleaching chemical agents was reduced to 2 percent, another South African dermatologist, N. Hardwick, conducted a survey in two Pretoria research hospitals by randomly selecting 194 outpatient subjects who came to these research facilities for reasons other than skin problems. 53 males and 141 females were selected. (32) The result of this research was that 68 patients (35 percent of the total 195 patients) had exogenous ochronosis. Of the 68 patients with exogenous ochronosis, 12 patients who started using hydroquinone-based bleaching preparations after 1983 had the condition. In their analysis, Hardwick et al. (1989) had chosen 1983 as a cut-off-period to give the old hydroquinone-based skin-bleaching preparations containing 8 percent concentration sufficient time to be off the market. However, this new finding, which contradicted the claim that 2 percent hydroquinone is a "safe" skin-bleaching chemical, did not change the legal status of skin-bleaching products in apartheid South Africa or in the west. Hardwick's findings suggest that even in 2 percent concentration, hydroquinone causes skin damage. In addition, Schulz et al. (1990) have argued that skin damage resulting from hydroquinone poisoning depends on the amount of hydroquinone absorbed by the skin which, in turn, depends on the frequency and duration of application and not on the concentration in hydroquinone. (33)
The reasons for resisting a ban on these poisonous chemicals in the west and in South Africa are many and complex. One of the reasons why medical communities in the west, as well as in the Southern hemisphere nations, are reluctant to ban skin-bleaching chemical poisons like hydroquinone is that hydroquinone and its derivatives have entered, in the broadest sense, the cosmetics and dermatology industries. Some dermatologists have started using hydroquinone in their practices to treat women with skin "blemishes," "freckles," and "age spots" who are willing to pay the cost of "safe," "customized" hydroquinone preparations which meet their needs.
From this perspective, hydroquinone-based skin-bleaching practice has created two classes of users: black and other women of colour who are assumed to use hydroquinone and other skin-bleaching chemicals because they desire whiteness, and "white" women, who use skin-bleaching agents "judiciously" to remove blemishes, freckles and age spots. (34) In South Africa, the only country where substantive research on the phenomenon of skin-bleaching has been done, the primary subjects of inquiries have been exclusively black. The other three racial groups under the apartheid system, Asians, "Coloureds" and "Whites," were not included in any of the published medical reports I have come across so far. Hence, the leading South African dermatologists who published on the problem of skin-bleaching, while agreeing that the biggest users of skin-bleaching were, indeed, white women, saw no need to see if white women who used hydroquinone-based skin-bleaching agents suffered similar medical conditions to those suffered by black women using the same skin-bleaching agents. (35)
Hydroquinone judiciously used is a valuable bleaching agent. Indeed, some well-formulated brands of the type of agent studied here have been useful for the removal of blemishes in Whites which may otherwise be difficult to treat. With due supervision, our patients have been astonished in the cheapness and excellence of such preparations when used with care and suitable adjuvant measures. (36)
Given that Findlay et al. reported that hydroquinone when used by black women and black men resulted in so much suffering and damage, it is not clear why white women and men who bleach their skin with the same hydroquinone-based skin-bleaching preparations would not suffer the same skin damage. However, a closer look at the apartheid racist politics reveals a more complex regime of social, cultural, scientific and political practices through which whiteness as a superior racial category has been constructed and legitimated. In this context, the use of skin-bleaching chemicals by white women under the apartheid regime under the pretext of removing "blemishes," "freckles" and "age spots" from white bodies is meant to safeguard the whiteness of whites, who ruled nonwhite people on the premise of the alleged moral superiority of white people over nonwhite people.
This alleged moral superiority is supposedly manifested in the corporeal superiority of white bodies over nonwhite bodies. Consequently, conducting comprehensive research into the practice of skin-bleaching to see whether other groups beside blacks in South Africa were bleaching their bodies would have brought into question the validity of the racial boundary set according to the ideology of white supremacy: if, with the help of skin-bleaching chemicals, one might be able to "pass" for "white," then the epistemic foundation upon which the social and political order of racial apartheid rests becomes problematic, making it impossible to distinguish between those who are "really" white, and "impostors." Therefore, by limiting the research only to black subjects, the South African racist medical establishment sought to simultaneously uphold the alleged superiority of whiteness by showing the futility, in the attempts made by black women and men who foolishly desire to possess whiteness, of bleaching their skin. I n fully racialized societies such as South Africa under the apartheid regime, "blemishes" on white bodies may signify a racial impurity of the dominating white ruling class. And since women are the locus of racial reproduction, all attempts must be made to make sure that white women appear as white as possible. When used by black women and other women of colour, skin-bleaching is considered by the white supremacist medical establishment as a self-destructive and misguided practice, but when used by white women it is considered by the same medical establishment as a "judicious" medical practice. In this context, in the case of white women, their skin-bleaching practice is represented as a limited and medically necessary practice designed to remove "dirty marks" and "blemishes" from the white female bodies. Dirty marks, blemishes and freckles which, if not removed, could put in question the racial purity of the white supremacist race.
Dyer argues that the alleged purity of the whiteness of the white female body has been central to the construction of the white race in the west (Dyer, 1997, p. 55). In South Africa, even post-apartheid, the practice of skin-bleaching continues, (37) though both the state and the medical community are fighting the importation of skin-bleaching chemicals. (38) However, Nigeria, Africa's largest country and now the leading producer of hydroquinone-based skin-bleaching chemicals, recently legalized the production, distribution and sales of hydroquinone-based chemicals and other chemicals used for skin-bleaching. (39) Nigeria and other third world countries are often used as off-shore skin-bleaching chemical production and distribution sites for the western-based pharmaceutical industry. The process has created a global network that links together the producers of hydroquinone's chemical precursors, and producers and distributors of finished products for the purpose of making profit.
"Not in Our Genes": Poisonous Medicine and the Politics of Race
In this final section of the paper, I take a critical look at the specific ways in which North America's medical community has responded to the health questions associated with skin-bleaching. This analysis is necessary given the fact that skin-bleaching is a major industry in the United States and to a lesser degree in Canada.
Skin-bleaching has been as much a part of US national history as the organized system of slavery and legalized racial segregation. In this fully racialized society, the amount of pigmentation on one's skin often meant the difference between living in servitude or as a free person, receiving education or being denied it, living well off or being poor, being considered attractive or ugly. In this state of total dehumanization, African Americans have sought ways to lighten their skin and straighten their hair. According to the published literature, Ro-Zol is one of the oldest chemical agent manufactured in the United States for the purpose of skin-bleaching. The following advertisement for Ro-Zol was very explicit about its promise to give blacks the social respectability they so lacked because of their skin colour:
Ro-Zol was the first preparation made expressly for bleaching....Ro-Zol does not bleach by destroying the pigmentation....It is received by the pigment and combines and harmonizes to produce a remarkably satisfactory, youthful, wholesome and whitened complexion. (40)
Currently, one can walk in to any American or Canadian drug store, or "beauty" salon serving blacks and other people of colour, and pay for skin-bleaching creams, ointments and soaps with names such as Ambi Fade Creme, Esoterica, Porcelana, Vantex, and Venus de Milo. Most over-the-counter skin-bleaching chemicals available in the United States, Canada and Europe contain hydroquinone. In the United States, in 1990, $44 million of over-the-counter skin-bleaching products were purchased. (41) This figure does not reflect the use of hydroquinone-containing chemical agents sold as prescription drugs or in cosmetics which contain hydroquinone but which do not list it. Most over-the-counter hydroquinone-based skin-bleaching preparations available in the United States, Canada and Europe follow the 1983 South African 2 percent upper limit guideline. (42) And some American dermatologists have vigorously advocated for the use of hydroquinone as a drug to treat various skin conditions such as acne and melasma. (43)
However, despite publications by Findlay et al. (1975, 1980), Hardwick et al. (1989), Schulz et al. (1990) -- all of whom have linked the use of hydroquinone-based skin-bleaching agents to a permanent skin damage, exogenous ochronosis -- the American, Canadian and European medical communities, to my knowledge, have not undertaken sustained research on the health risks associated with the use of over-the-counter hydroquinone-based skin-bleaching agents. There are several reasons for the strategic silence in the part of North American and European medical communities with respect to the health risks associated with the use of these chemicals. For one, as was the case in South Africa, the biggest users of skin-bleaching agents, including hydroquinone, in Europe and in North America are white women.
However, when catering to the needs of white women, pharmaceutical/cosmetics industries put greater emphasis in their advertising on how their products will make their customers attain "beautiful," "pure," "translucent," "healthy looking skin." I argue that these adjectives signify whiteness. The cosmetics industry, which caters mainly to white, middle-class women, also uses other regimes of chemicals, such as alpha hydroxy acids (AHA) and kojic acids, products which can produce the whitening effects of hydro-quinone, presumably without the carcinogenic potentials associated with hydroquinone. (44) In some cases, a combination of alpha hydroxy acids and hydroquinone are offered to age conscious middle-class white women as an anti-ageing, anti-oxidant panacea. (45) What is striking about this new twist to the politics of whiteness (46) is that these cosmetics and potentially harmful chemicals are often sold in upscale "health" stores which cater mainly to white middle-class women and men. As a recent article i n Time Magazine demonstrated, in order to meet the growing demands of affluent and age conscious white middle-class women and men, even an ex-space scientist has produced his own brand of "anti-ageing" formula which sells for $85 US a jar. (47) Furthermore, skin-bleaching chemicals are being increasingly marketed to customers by medical doctors and dermatologists. The following ad is an example of this growing trend:
Glycolic Acid (AHA) formulations that decrease fine wrinkles, roughness, blotchiness and acne: developed by Dr. Harold Clavin (board certified in plastic and reconstruction surgery), these products contain the highest concentrations of Alpha Hydroxy Acids, Vitamin C, Vitamin A, and Hydroquinone available for home use without a doctor's approval. A proven medical solution to reduce sagging, wrinkled, pigmented, or acne prone skin. (48)
The fact that Dr. Clavin's skin-bleaching products cater to affluent white women is evidenced by an image of a white woman with a "winning smile" inserted in the same page containing this advertising. On the other hand, RXMED, a US-based coalition of family physicians, offers a plethora of hydroquinone-based cosmetics as legitimate drugs to their less affluent patients. (49) Not to be outdone, other US cosmetics companies have created "off-shore" skin-bleaching cosmetics lines in Japan, South Korea, Taiwan and Hong Kong. These skin-bleaching products cater to emerging middle-class Asian women. Hence, according to information posted on an internet site which offers information about various skin-bleaching products available in the market, Estee Lauder has a skin-bleaching line called Swiss Whitening marketed to Asian women in Korea, Taiwan, Hong Kong and Japan. However, the writer argued that the company is reluctant to introduce the product to the North American market because of the "highly charged emotional implications for selling a product called whitening." (50)
In contrast, Asian owned cosmetics companies such as DuBon, Amerean and Kose Cosmetics, and Shiseido, to name just a few, offer a wide range of skin-bleaching products which are openly sold in Asia, Europe and North America. (51) The emergence of "upscale" skin-bleaching regimes for the wealthy class coincided with an equally interesting phenomenon of the "health" industry. For example, according to Michael Rhodes (1996), a journalist with the Boulder County Business Report (Colorado), a Seoul-based cosmetics company called Nam Yang International (Korea), and the producer of aloesin, a skin-bleaching agent that is derived from the aloe vera plant, had opened two new subsidiary biotech companies in the United States: Univera Phytoceuticals in Bloomfield and Aloecorp in Texas. (52) What intrigues me about the business practices of this company is that one of the aims of Univera Phytoceuticals is to research and, presumably, find drugs that will cure skin cancer! However, the company derives its current business notoriety not from discovering any proven anti-cancer drugs but by its globally successful skin-bleaching product, aloesin. Steve Orndorff, chief operating officer with Univera Phytoceuticals Inc., corroborates this point in Rhodes' article:
"Aloesin is the first product manufactured by Univera, which now is being sold in Korea as a skin-bleaching product and for treatment in hyperpig-mentation," said Orndorff. While popularity of the product is high in Asia, he said, it is growing in popularity in North America and even in South Africa, especially with the older generation....The compound can be applied to the skin after exposure to ultraviolet light in order to prevent cancer. (53)
It is pertinent to ask in what specific way does a compound that destroys the skin's natural defence against ultraviolet light, melanin, at the same time enhance the skin's "protection" against harmful ultraviolet rays? This link makes sense if we take into account that historically in western medical and aesthetic literature, corporeal blackness, signified by the level of melanin pigment in the skin, had been identified as a sign of racial degeneracy and a locus of moral darkness and disease (Fanon, 1967; Whiting, 1999). In my view, the connection between blackness and what Fanon called a "corporeal malediction" informs, albeit in more subtle ways, the often racist manner in which westerners (especially members of the US medical community) have so far responded to the health risks associated with the practice of skin-bleaching.
In the main, silence has been the chosen strategy adopted by the western medical authorities with respect to the massive health implications associated with the practice of skin-bleaching. In the few instances where they have addressed some of the health risks associated with the practice, the North American medical community has sought to link the medical risks associated with the use of carcinogenic skin-bleaching agents such as hydraquinone to an imagined black genetic predisposition to getting skin damage! Even though, to the best of my knowledge, there has never been a credible published research finding which has made a causal link between genetic predisposition and the chance of getting exogenous ochronosis with hydroquinone, medical literature on the issue published in the United States has often suggested a racially-based genetic link between skin-bleaching and exogenous ochronosis. (54)
To back up my claim I have selected three articles on the topic of skin-bleaching and exogenous ochronosis published in three different but comparable professional journals in the field of dermatology. These three articles deal with four women from three different racial groups, a white woman, two African-American women and one Mexican-American woman. All four women have suffered from exogenous ochronosis after using 2 percent hydroquinone-based over-the-counter skin-bleaching creams. The first article I want to address appeared in 1985 in the journal Arch Dermatol. (55) The authors acknowledged in their cited literature that exposure to phenol and resorcinol, chemical compounds which are similar to hydroquinone, have been linked to exogenous ochronosis. (56) However, in their analysis, rather than treating hydroquinone as a potentially carcinogenic agent which may be responsible for the skin damage suffered by the subjects in their case studies (who, according to the authors, have admitted using hydroquinone -based skin-bleaching agents), the authors of this report steered the analysis away from the carcinogenicity of hydroquinone by insisting that the patients in question had some "unknown" black genetic predisposition for getting exogenous ochronosis, which, perhaps incidentally, may have been triggered by exposure to hydroquinone. In order to establish an imagined black genetic predisposition to getting exogenous ochronosis, the authors make two interesting textual moves: first, they claimed that Findlay's case study which linked skin-bleaching to exogenous ochronosis suffered by 35 South African Black women may have indicated the presence of certain histological pathogenesis similar to the ones described in Pick's 1906 report involving white German workers exposed to phenol, (57) but insisted that the Black women in Findlay's report suffered from something quite different.
Second, to make the case for their preferred alternative explanation, that there is a link between black genetic predisposition and getting exogenous ochronosis, the authors have denied a link between carcinogenic effects associated with the use of hydroquinone-based skin-bleaching agents and getting exogenous ochronosis by saying that, "Despite the widespread use of similar hydroquinone bleaching creams in the United States, there has been only one previously published report of a similar reaction occurring in this country." (58)
Finally, despite clear evidence of pain and suffering associated with hydroquinone-based skin-bleaching preparation evidenced by the severe medical conditions of the two black women in their report, the authors vigorously insist that hydroquinone is not a carcinogenic agent but a valuable drug in treating certain forms of dermatitis:
There may also be a genetic factor that predisposes blacks to the development of this pigmentation. Such a factor would explain why cases of whites with this entity have not been reported despite the widespread use of hydroquinone bleaching creams, particularly for the treatment of melasma, lentigines, and ephelides. These creams are certainly used to treat sun-exposed skin for prolonged periods of time. (59)
In their prediction of the problem, authors of this report had placed the blame not on the producers of these poisonous chemicals but on the black female patients in their report, who may possess an "unknown" genetic predisposition for suffering skin damage.
The next piece I want to address here was published in 1988 in the Journal of the American Academy of Dermatology. It describes a case involving an elderly white female patient who developed severe facial hyperpigmentation and skin irritation after using, for a number of years, over-the-counter 2 percent hydroquinone- and mercury-based skin-bleaching creams. There are several interesting points which separates the manner by which the authors have described this patient's condition from the ways in which people of colour with the similar conditions are often described by the western medical establishment. First, she is represented as a blameless person who acted on "misinformation" in using potentially carcinogenic skin-bleaching agents because she had some persisting "hypopigmented" area in her face which she wanted to blend in with the rest of her face. (60)
Second, hydroquinone is represented here as a carcinogenic agent directly responsible for this patient's negative experience after using over-the-counter skin-bleaching chemicals. Consequently, the authors have "warned the patient of the potential consequences of long-term use of hydroquinone-containing bleaching creams." (61) Third, the authors' expert recommendations to the white woman -- that hydroquinone-containing skin-bleaching could present serious risks -- bring to bear a prior knowledge of the severe skin damage and "stigma" associated with the use of hydroquinone skin-bleaching chemicals suffered in the past by nonwhite people. And yet, it is only when a white patient had a negative experience with skin-bleaching that the medical establishment acknowledges the need to treat hydroquinone as a carcinogenic agent:
If these deposits are ochronotic, one must then wonder what role they played in the discoloration of the skin. The patient certainly, had none of the stigma of advanced ochronosis, that is, pigmented papules, milia, and nodules. If these deposits do represent exogenous ochronosis, the case presented here is even more unusual because, to the best of my knowledge, this entity has not been described in whites. (62)
As far as these authors are concerned, regardless of the availability of contrary evidence, blacks who use hydroquinone-based bleaching agents often get skin damage not from the use of carcinogenic agents, but because they possess a prior genetic predisposition to getting skin damage, when they bleach their skin with carcinogenic agents!
The final article I want to address here was published in 1990 in the journal Cutis. It concerns a Mexican-American woman who had suffered from a severe case of exogenous ochronosis after using over-the-counter 2 percent hydroquinone skin-bleaching cream for a period of six months. This story interests me because the authors have attempted to solidify and corroborate some of the key racist premises which frame discussions on skin-bleaching in dominant western medical journals.
As a result, the authors have used this woman's negative experience with hydroquinone to make a causal link between the use of hydroquinone based skin-bleaching agents and a supposed black genetic predisposition to getting exogenous ochronosis.
Exogenous ochronosis, or hyperpigmentation resembling ochronosis, is a syndrome of cutaneous pigment deposition associated with the topical application of various agents including hydroquinone, phenol, resorcinol, and picric acid, as well as both parenteral and intramuscular antimalarial drugs. This syndrome derives its name from the clinical appearance of cutaneous blue-black hyperpigmentation and the presence of histologic examination of ochronotic deposits in the dermis. With possible exceptions, this syndrome has been reported only in black women. (63)
Even though the woman of colour in the report has explicitly told them that she has used 2 percent hydroquinone over-the-counter skin-bleaching cream, which she suspected was the cause of her facial disfigurement, these doctors insisted that the "real cause" of her adverse experience may be linked to certain "unknown," black "blood" deeply "hidden" in her genes! "She had no known black ancestors and no family history of similar symptoms." (64)
To the best of my knowledge, there has not been any scientific study which provided a scientific basis for a possible connection between the use of poisonous skin-bleaching chemicals such as hydroquinone, and a black genetic predisposition to getting skin damage from skin-bleaching. The supposed black genetic predisposition to getting exogenous ochronosis and similar skin conditions in the presence of skin-bleaching chemicals such as hydroquinone have been more in the minds of the mainly white western medical establishment than in the genes of black subjects. What troubles me the most, however, about the dubious manner in which the medical establishment has sought to fabricate a black racial genetic predisposition to getting exogenous ochronosis -- a skin condition which clearly results from the use of highly poisonous carcinogenic agents -- is that the false claims of these doctors have the power to influence health, political and economic policies with serious implications.
Despite the prevailing white supremacist medical establishment which seeks to minimize the health implications of skin-bleaching, it is nevertheless a damaging practice which threatens the psychic and bodily integrity of those who, in order to get a bit of whiteness, risk their physical and emotional wellbeing. In order to confront this devastating phenomenon, it is necessary that we continue to interrogate the medical, social, political and economic discourses which construct, sustain and legitimate the global system of capitalist white supremacy. It is by taking this integrated approach that we might be able to confront the destructive practice of skin-bleaching.
I would like to thank Mary Catherine Leng for her insightful comments on early drafts of this paper, Kathryn Morgan for her unfailing support, Kari Dehli for her support and encouragement, Caralee Price and Frieda Forman for their kindness and support during the initial stages of this research project, Phil Masters for encouraging me to submit the paper to RFR/DRF, and my daughter, Idil, for boundless love and support.
Amina Mire is currently a doctoral candidate in Sociology and Equity Studies in Education at OISE/UT and in the Collaborative Women's Studies Program at the University of Toronto.
She also has degrees in philosophy and chemistry, and an assistant pharmacist's diploma.
(1.) During my research for this paper, I came across countless Internet websites owned and operated by dermatologists and medical doctors who sell skin-bleaching creams as panacea for plethora of skin conditions such as "aging spots," "freckles," "wrinkles," acne and similar skin ailments.
(2.) Serge F. Kovaleski. "In Jamaica, Shades of an Identity Crisis: Ignoring Health Risk, Blacks Increase Use of Skin Lighteners." The Washington Post, Thursday, August 5, 1999, p. A 15.
(3.) By "nonwhite" I mean those groups of peoples who in the context of European colonial conquest have been rendered fit for colonial dispossession, subjugation and, in the final analysis, elimination. Given Hitler's attempt to eliminate 6 million Germans with Jewish cultural heritage, and the fact many groups who have been colonized by Europeans contain, in some cases, people who are phenotypically "white" makes the term "Black people," which seeks to divide people into black and white, problematic. Equally problematic is the term "people of colour," which seeks to divide people into those with colour and those without colour. As a result, both of these terms seem inadequate to address the complexities of the history of colonialism. However, when the context warrants, I will use both black people and people of colour in this work.
(4.) Donald Briscoe. "Methyl Mercury Ingestion." Clinical Toxicology Review vol.18, no.6 (March 1996); J. Delwyn Dyall-Smith and James P. Scurry. "Mercury Pigmentation and High Mercury Levels from the Use of a Cosmetic Cream." The Medical Journal of Australia vol.153 (October 1, 1990), pp. 409-414; R.D. Barr et al., "Nephrotic Syndrome in Adult in Africans in Nairobi." British Medical Journal, April 15 1972; Sun Chee-Ching, "Allergic Contact Dermatitis of the Face from Contact with Nickel and Ammoniated Mercury in Spectacle Frames and Skin-lightening Creams." Contact Dermatitis vol. 17 (1987), pp. 306-309.
(5.) David Quing. "Cysteine Metabolism and Metal Toxicity." Alternative Medicine Review vol. 3, no.4(1998), pp.267-270.
(6.) Patricia G. Engasser and Howard I. Mailback. "Cosmetics and Dermatology: Bleaching Creams." Journal of the American Academy of Dermatology vol. 5, no.2 (August 1981).
(7.) J.F. Villanacci et al. "Mercury Poisoning Associated with Beauty Cream-Texas, New Mexico and California, 1995-96." Morbidity and Mortality Weekly Report vol. 45, no.19 (May 17, 1996), pp. 400-403; In 1997, the Canadian Ministry of Health banned the importation, distribution and sales of Diana, an ammoniated mercury-based skin-bleaching cream made in Lebanon and distributed world wide by a company called Diana de Beaute. The banning of Diana in Canada came about as the result of my efforts and the efforts of my friend, Dr. Abdi Jowhar, who at that time was a general medical practitioner in Edmonton, Alberta. Together, we sent a sample of Diana cream to the University of Alberta's toxicology lab. The laboratory results indicated that ajar of 200 ML contained 18 grams of ammoniated mercury. However, mercury-based skin-bleaching soaps, creams and ointment with different brand names are still available in Canada.
(8.) Goeckermann, William H. "A Peculiar Discoloration of the Skin: Probably Resulting from Mercurial Compounds (Calomel) in Proprietary Face Creams." Journal of American Medical Association vol.79, no. 8 (August 19, 1922), pp. 605-607.
(9.) Dyall-Smith and Scurry, pp. 409-410.
(10.) See John Gilkeson, "Issue Paper: The Department of Defense (DoD) and Energy (DoE) bold about 11 million pounds of Hg that they intend to resume selling, contingent on a favorable outcome to an environmental assessment, which is nearing completion. Minnesota Office of Environmental Assessment." May, 1996, United States Environmental Protection Agency (EPA). For further information, see EPA website: http://www.epa.gov/toxteam/hgssfipl.htm.
(11.) Morbidity and Mortality Weekly Report (MMWR) vol. 45, no.29 (1996), pp. 633-635.
(12.) Kovaleski, Serge F. "In Jamaica, Shades of an Identity Crisis." The Washington Post August 5, 1999, p. A 15.
(13.) Mori, Moira, Nicola Pimpinelli and Benvenuto Giannotti. Drug Safety vol. 10, no. 5 (1994).
(14.) Mosby's Medical Encyclopedia, CD-ROM version 6.1. One Athenaeum Street, Cambridge, MA 02142, ISBN# 1-56434-919-5 (1995).
(15.) Mosby's Medical Encyclopedia, CD-ROM, 1995.
(16.) Moira Mod et al., p. 408.
(18.) Machet, L., Jan V. Machet, L. Vaillant and G. Lorette. "Cutaneous Alternariosis: Role of Corticosteroids-Induced Cutaneous Fragility." Dermatology vol. 193 (1996), pp. 342-344.
(20.) In Jamaica, the term "brownin" refers to people with lighter skin colour.
(21.) Kovaleski, p. A 15
(22.) Russell, Kathy, Midge Wilson and Ronald Hall. The Color Complex: The Politics of Skin Color Among African Americans (New York, London, Toronto, Sydney, Auckland: Anchor Books, 1992), p.51
(23.) Ibid., pp. 51-53.
(24.) Hardwick, N., L.W. Van Gelder, C.A. Van Der Merwe and M.P. Van Der Merwe. "Exogenous Ochronosis: An Epidemiological Study." British Journal of Dermatology vol. 120 (1989), pp. 229-238.
(25.) Findlay, G.H.; J.G.L. Morrison and I. W. Simson. "Exogenous ochronosis and pigmented colloid millium from hydroquinone bleaching creams." British Journal of Dermatology vol. 93 (1975), p. 613.
(26.) Snider, Rebecca and Brace H. Their. "Exogenous Ochronosis." Journal of the American Academy of Dermatology vol. 28, no. 4 (April 1993), pp. 662-666.
(27.) Hardwick et al., pp. 229-230.
(28.) In 1990, in the United States alone, some $44 million worth of hydroquinone-based skin-bleaching products were purchased. See Russell et al., p. 52, And in South Africa, in 1979, 25 million Rands worth of hydroquinone-based skin-bleaching products were purchased. In 1986, in South Africa, that figure jumped to 94 million Rands, or about $30 million. See Hardwick et al., p. 238.
(29.) Findlay et al., p. 313.
(30.) Hardwick et al., pp. 229-238.
(31.) Findlay et al., pp. 613-622.
(32.) Hardwick et al., pp. 229-238. It wasn't mentioned in the article whether these patients were willing participants in this research or were forced to participate in it. In fact, there is some evidence that at least some of these patients were willing to suffer in silence rather than seek medical help from the agents of the apartheid regime. This point is supported by the fact that 108 out of the 195 subjects selected for the research denied using skin-bleaching chemicals (even though the researchers have shown that some of these patients did bleach their skin, and as a result, had exogenous ochronosis), which suggests that they were not willing participants in the research.
(33.) Schulz, E .J., M.A. Sher. "Rescinding of legislation to ban hydroquinone-containing creams." South African Medical Journal. vol. 77 (1990), p. 372. Reprinted in the British Medical Journal vol.305 (1992), pp. 903-904.
(34.) G. H. Findlay and H. A. De Beer. "Chronic Hydroquinone Poisoning of the Skin from Skin-Bleaching Cosmetics." Sa Mediese Tydskrif February 9, 1980, p. 187.
(35.) Findlay and De Beer, pp.187-190.
(36.) Ibid., pp. 187-190.
(37.) Maphumulo, Mandulo. " 'White blacks' pursue faded cream of beauty." The Sunday Independent, June 13, 1999.
(38.) Schuler, Corinna. "Africans look for beauty in Western mirror." Christian Science Monitor, December 23, 1999.
(39.) Oculi, Okello, "On Nigeria's Skin War." Source: Abuja Morro, 23-29, 2000, http:www.ndirect.uk/-n.today/mfeat151.htm. Today Communication Ltd., pp. 1-3.
(40.) Russell et al., p.50.
(41.) Ibid., p. 51.
(42.) Williams, Hywel. "Skin Lightening Creams Containing Hydroquinone: The Case for a Temporary Ban." British Medical Journal vol.305 (1992), pp. 903-904.
(43.) Engrasser and Mailback, pp.143-147.
(44.) Advertisement. "'C' -- Vitamin C-based skin-bleaching cosmetics by Jason Natural Cosmetics." Alive: Canadian Journal of Health and Nutrition no. 189 (July 1998), p.3. [Source: Women's Educational Resources Centre, Centre for Women's Studies in Education, OISE/UT.]
(45.) Romano, James J. "Cosmetic Surgery of the Face and Body." Source: www.jromano.com. July 15, 2000.
(46.) All skin-bleaching chemicals disrupt the body's ability to produce the skin's natural pigment, melanin, thus increasing the risk of sun-induced skin cancer.
(47.) Gorman, Christine. "Face Lift in a Jar?" Time Magazine August 14, 2000, pp. 31-34.
(48.) Source: http://www.clavin.com. Address: Dr. Harold Clavin, 2001 Santa Monica Blvd, Suite 890 West, Santo Monica. California 90404-2172.
(49.) Source: RXMED: http://www.rxm.com.
(50.) The Asian American Woman. Source: http://asians.net/Skin/Lightten , July 16, 2000.
(51.) Wes Young. Source:http:www.amagzine.com, July 15, 2000.
(52.) Michael Rhodes. "Univera Explores Anti-cancer Potential of Aloe, Other. Plants." Boulder, Colorado, Boulder County Business Report, 1996 (see http:www.bcbr.com/sep96/hitch2.htm).
(54.) See L. Pick's article "Uber Die Ochronosis." Klin Wochenschrift vol. 43 (1906), p. 478. Dr. Pick was the first physician who made the link between exposure of harmful chemical compounds similar to hydroquinone to humans and the damaging skin condition "exogenous ochronosis."
(55.) Horshaw, Richard, Kent G. Zimmerman and Alan Menter. "Ochronosislike Pigmentation from Hydroquinone Bleaching Creams in American Blacks." Arch Dermatol vol. 121 (January 1985), pp.105-108; Howard, Kris L. and Bonnie B. Furmer. "Exogenous Ochronosis in a Mexican-American Woman." Cutis vol.45 (March 1990), pp.179-182; Pearson G. Lang. "Probable Coexisting Exogenous Ochronosis and Mercurial Pigmentation Managed by Dermabrasion." Journal of the American Academy of Dermatology vol.19, no.5 [part 2] (November 1988), pp. 942-946.
(56.) Thomas, A.E. and M.A. Ginsburg. "Exogenous Ochronosis and Myxoedema from Resorcinol." British Journal of Dermatology vol. 73 (1961), pp. 378-381 quoted in Horshaw et al.; L. Pick, p. 478.
(57.) L. Pick, p. 478. Quoted in Horshaw, p. 105.
(58.) Horshaw et al., p. 105.
(59.) Ibid., p. 108.
(60.) Lang, p. 942.
(61.) Ibid., p. 946.
(62.) Ibid., p. 945.
(63.) Howard and Furner, p.180.
References -- Non-Medical
Dyer, Richard. White. London, New York: Routledge, 1997.
Fanon, Frantz. Black Skin-White Masks. New York: Grove Press, 1967.
Goldberg, Theo David. Racist Culture: Philosophy and the Politics of Meaning. Oxford & Cambridge, Mass.: Blackwell, 1993.
Gorman, Christine. Face Lift in a Jar? Time Magazine (Canadian Edition), August 14, 2000.
hooks, bell. Black Looks: Race and Representation. Toronto: Between the Lines, 1992.
Maphumulo, Mandulo. " 'White blacks' pursue faded cream of beauty." The Sunday Independent; June 13, 1999.
McClintock, Anne. Imperial Leather: Race, Gender and Sexuality in the Colonial Contest. New York/London: Routledge, 1995.
Mills, Charles. The Racial Contract. Ithaca/London: Cornell University Press, 1997.
Oculi, Okello. "On Nigeria's Skin War." Today Communication Ltd: Abuja Mirror, February 23-29, 2000.
Rhodes, Michael. Univera Explores Anti-Cancer Potential of Aloe, Other Plants. Boulder County Business Report, 2000.
Russell, Kathy, Midge Wilson and Ronald Hall. The Color Complex: The Politics of Skin Color Among African Americans. New York, London, Toronto, Sydney, Auckland: Anchor Books, 1992.
Schuler, Corina. "Africans Look for Beauty in Western Mirror: Black Women Turn to Risky Bleaching Creams and Cosmetic Surgery." Christian Science Monitor December 23, 1999.
Kovaleski, Serge F. "In Jamaica, Shades of an Identity Crisis: Ignoring Health Risks, Blacks Increase Use of Skin Lighteners." The Washington Post; Thursday, August 5, 1999, p. A. 15.
References -- Medical
Aronow, Regine. "Heavy Metals and Inorganic Agents." Annals of Internal Medicine vol.76, no.5 (May 1972).
R.D. Barr et al. "Nephrotic Syndrome in Adult in Africans in Nairobi." British Medical Journal, April 15, 1972.
Donald Briscoe." Methyl Mercury Ingestion." Clinical Toxicology Review vol.18, no.6 (March 1996).
Dyall-Smith, Delwyn J and James P. Scurry. "Mercury Pigmentation and High Mercury Levels from the Use of a Cosmetic Cream." Medical Journal of Australia vol. 153 (October 1, 1990), PP. 409-415.
Engasser, Patricia G. and Howard I. Maiback. "Cosmetics and Dermatology: Bleaching Creams." Journal of the American Academy of Dermatology vol. 5, no. 2 (August 1981), pp. 143-147.
Hardwick, N, L. W. Van Gelder, C.A. Van Der Merwe and M.P. Van Der Merwe. "Exogenous Ochronosis: An Epidemiological Study." British Journal of Dermatology vol.120 (1989), pp.229-238.
Howard, L. Kris and Bonnie B. Furner. "Exogenous Ochronosis in a Mexican-American Woman." Cutis vol.45 (March 1990), pp. 180-182.
Horshaw, Richard A., Kent G. Zimmerman and Alan Menter. "Ochronosislike Pigmentation From Hydroquinone Bleaching Creams In American Blacks." Arch Dermatol vol. 121 (January 1985), PP. 105-108.
Findlay, G.H, J. G.L. I. Morrison and I.W. Simson. "Exogenous Ochronosis and Pigmented Colloid Milium From Hydroquinone Bleaching Creams." British Journal of Dermatology vol. 93 (1975), PP.613-622.
Gilkeson, John. "Federal Sales of Mercury (Hg): United States's Environmental Protection Agency." 1996. See http://www.epa.gov/toxteam/hgssfipl.htm
Goeckermann, William H. "A Peculiar Discoloration of the Skin: Probably Resulting from Mercularial Compounds (Calomel) in Proprietary Face Creams." Journal of American Medical Association vol.79. no.8 (August 19, 1922), pp.605-607.
Lang, G. Pearson. "Probable Coexisting Exogenous Ochronosis and Mercurial Pigmentation Managed by Dermabrasion." Journal of the American Academy of Dermatology vol.19. no.5 [part 2] (1988), pp.942-946.
Machet, L, M.C. Machet, L. Vaillant and G. Lorette. "Cutaneous Alternariosis: Role of Corticosteroid-Induced Cutaneous Fragility." Dermatology vol.193 (1996), pp. 342-344.
Mori, Moira, Nicola Pimpinelli and Benvenuto Giannotti. "Topical Corticosteroids and Unwanted Local Effects: Improving the Benefit/Risk Ratio." Drug Safety vol. 10, no. 5 (1994), pp. 406-407.
Pick, L. "Uber die Ochronose." Klim Wochenschrift vol. 43 (1906).
Quing, David. "Cysteine Metabolism and Metal Toxicity." Alternative Medicine Review vol. 3, no.4 (August 1998), pp. 262-270.
Romano, James J. "Cosmetic Surgery of the Face and Body." Source: http://www.jromano.com. July 2000.
Schulz, E.J. and M.A. Sher. "Rescinding of Legislation to Ban Hydroquinone Containing 2%." South African Medical Journal vol. 77 (1990), p. 372.
Snider, Rebecca and Bruce H. Their. "Exogenous Ochronosis." Journal of the American Academy of Dermatology vol. 28, no. 4 (April 1993), pp. 662-666.
Sun, Chee-Ching. "Allergic Contact Dermatitis of the Face from Contact with Nickel and Ammoniated Mercury in Spectacle Frames and Skin-lightening Creams." Contact Dermatitis vol. 17 (1987), pp. 306-309.
Thomas, A.E. and M.A. Ginsburg. "Exogenous Ochronosis and Myxoedema from Resorcinol." British Journal of Dermatology vol.73 (1961), pp. 378-381.
Villanacci, J F, M.D. Beauchamp, D.M. Perratta, K. Hendricks, M. Rodriguez, R.J. Dutton, K. Sutton, J. Duran, D.M. Simpson, K. Richards, D. Nelson, F. Crespin, M. Bartzen, M. Ginsberg, L. Senini, F. Nava, S. Richardson, S. Waterman, M.G. Lombera, M.A. Ruiz, P. Cravioto, O. Saldate and G. Flores. "Mercury Poisoning Associated with Beauty Cream -- Texas, New Mexico and California, 1995-1996." Morbidity and Mortality Weekly Report vol. 45, no.19 (May 17, 1996), pp. 400-403.
Williams, Hywel. "Skin Lightening Creams Containing Hydroquinone: The Case for a Temporary Ban." British Medical Journal vol. 305 (1992), pp. 903-904.