‘Fairness Mania’ Is Fueling a Dangerous Drug Dependence in India

A message notification from a stranger. That was all it took for Soma Banik to be transported back to her teenage years, and for the memories of all the “horrific things” she went through to come flooding back.

The stranger in question was Janet James, who reached out to her one afternoon in June 2018. “I need your help,” James messaged Banik on the social networking platform Quora. She described how she had been using a cream containing the steroid Betamethasone for over two years to lighten her skin and was experiencing disturbing side-effects. “Whenever I stop using it, my face starts itching and small blisters arise,” she wrote.

James had stumbled upon Banik’s skincare blog, in which she documents her own painful experience with topical steroid creams and had sent her an urgent plea for guidance.

Banik, who is now a 33-year-old state government employee from the suburbs of Kolkata, replied instantly. She gave James the advice she wished someone had given her: “Stop right away.”

Betamethasone is a potent topical corticosteroid medication habitually used to treat a wide range of skin conditions, including psoriasis and eczema, but one of the potential side effects is lightening of the skin.

Creams containing Betamethasone should only be used on the advice of a doctor and are typically acquired with a prescription. But in India, as CNN learned from doctors and users around the country, Betamethasone, and other corticosteroid creams, are regularly being misused as a skin lightening agent — mostly by women.

In 2003, when Banik was just 14, a neighbor told her mother how much their child had “benefitted” from becoming “fair” by using a new cream. “Your daughter will also become fair,” they said.

Wanting Banik to have the best prospects in a country where lighter skin is seen as desirable and associated with success, Banik’s mother took her neighbor’s advice. “I was disappointed that it came in a tube so unappealingly medicated,” Banik recalls, “but it held the secrets toward my fairer future.”

School friends were the first to notice, commenting on Banik’s newly acquired “good looks,” but within two months of using the steroid cream, she started to feel a burning sensation whenever she was out in the sun. She says she accepted this as part of the process: no pain, no fairness.

But one morning, the teenager forgot to apply the cream and within hours, a zit appeared on her chin. Though it quickly settled on applying the cream, Banik’s face started itching all the time. She soon developed acne and then, a year after the zit appeared, hair began to grow all over her face.

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CNN spoke with multiple Indian dermatologists all of whom confirmed that Banik’s symptoms — itching, acne, and hirsutism (hair on the face) — are signs of Topical Steroid Damaged/Dependent Face (TSDF), caused by the excessive or prolonged use of steroid creams.

Topical corticosteroids, such as Betamethasone, have several medical benefits, including anti-inflammatory effects, but they should only be used for short durations and under the supervision of a doctor, ideally a dermatologist. Extensive use can cause a range of side effects, including pustules, where big rashes appear on the face, dryness, hypopigmentation (lighter skin), hyperpigmentation (darker skin), or photosensitivity (reactions to sunlight).

It is the potential for hypopigmentation that is thought of as desirable by many women, and leads to misuse of the drug, in turn, fueling a dependency.

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Even though numerous painful and visible side effects could develop from topical corticosteroid misuse, dermatologists told CNN that the practice is rampant in India — despite the introduction of restrictions in 2018 to limit access to these drugs.

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“Fairness mania-induced use of topical steroids” is a silent epidemic of “astronomical magnitude,” says Dr Koushik Lahiri. He highlights a 2020 article in the BMJ Open, which listed “public and professional ignorance, legal ambiguity and government inaction” as contributing factors to the epidemic.

“Action must be taken to curb the sale and use of such creams as fast as possible,” he says.

At the root of the wide-spread misuse of topical corticosteroids in India is the deep-seated belief that lighter skin tones are better than darker ones. And nowhere is this more visible than in India’s marriage culture.

In 2014, in Gurugram, a city southwest of Delhi, a woman killed herself. Her sister told reporters that the woman had been “fed up [with] the taunting [she received from her husband] regarding her skin colour.”

A year later, a schoolteacher from Kolkata set herself on fire. Before she died in hospital, she is reported as having said that putting up with constant humiliation for her complexion, and being told no-one would marry her, was the reason she did it.

Matrimonial advertisements in the press clearly show the societal link between fair skin and desirability.

CNN analyzed ads posted in the Sunday editions of three of India’s biggest English-language newspapers — Times of India, The Telegraph and Hindustan Times — throughout the month of August, counting how many times the word “fair” was used, as well as similar terms such as “wheatish” or “medium complexion”. Of 1332 ads, 301 (22%) explicitly used these words, either as a selling point or as an attribute sought in a prospective match.

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A sample page from the Sunday Times of India, the country’s largest English language daily (by circulation), shows how common mentions of fair skin are in matrimonial ads.

Dhruba Mukherjee, CEO of ABP Pvt Ltd, the media group that owns The Telegraph, told CNN that while “the publishing house does not endorse the use of these terms, unless a word breaches the law, we cannot ask people to stop using any specific term”. He added that the ads “reflect the socio-cultural mindset of people”.

The Times of India did not respond to CNN’s request for comment and The Hindustan Times declined to comment.

Explaining the phenomenon, feminist activist and researcher Reena Kukreja says: “In large part, [the desirability of fair skin is] due to the association of dark skin with manual labour undertaken outdoors — dark skin was emblematic of low caste status”.

In an article published at the start of 2021, Kukreja outlined how “fairness as ‘capital’ conjoins with both regressive patriarchal gender norms governing marriage and female sexuality and the monetization of social relations, through dowry, to foreclose local marriage options for darker-hued women.” In other words, the darker-skinned and poorer you are in India, the harder it is for you to find a husband, and society reserves many privileges for married women.

“One thing I keep hearing is parents asking me to ‘fix their daughters’ skin problems fast,’” says dermatologist Dr Pallavi Kashyap. “Parents fear their daughter won’t find a prospective suitor unless they are fair.”

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