Unraveling the mirage of fairness cream commercials: A cross‐sectional analysis of commercials from South Asia

Fairness products are an essential component of daily beauty routines for many individuals in subcontinental Asia. However, it is important to be aware that these products often contain ingredients that can be detrimental to the skin and are banned in several developed countries.

lightening products for its skin lightening effects. 4Corticosteroids, another group of active ingredients, can suppress the production of melanin and reduce inflammation, resulting in temporary skin lightening effects. 2 However, these lightening agents come with a myriad of potential adverse effects, including cutaneous manifestations, predisposition to infections, and possible endocrinologic complications. 2 Another consideration of these cosmetic products is that they are typically used in the warmer climates and may increase percutaneous absorption in these settings, which can increase the likelihood and severity of adverse effects. 2 Hydroquinone, when used in high concentrations or for prolonged periods can lead to skin irritation, allergic reactions, and even permanent skin discoloration.Mercury is a highly toxic substance that can cause systemic health complications, including damage to the renal, nervous, and reproductive systems. 4Corticosteroids, if used inappropriately or without medical supervision, can cause thinning of the skin, increased vulnerability to infections, and disruption of the body's natural hormonal balance. 2  The cosmetic industry, as well as popular media outlets have led to the further propagation of this beauty standard, and with the increase in use of skin lightening products, fairness creams have become a mainstay in the Indian cosmetics culture.In recent years, there has been growing awareness surrounding the potential health risks and societal implications associated with the use of skin lightening products. 5There is a strong need for further regulatory measures to be implemented to restrict the use of certain ingredients and promote safer alternatives. 2cording to a study conducted in South Asia, 60% of respondents from Northern India reported having used fairness products at some point in their live, a prevalence comparable to that found in the African population. 6In a separate study conducted in Mumbai, India, approximately 40% of respondents reported using fairness products, with 17% experiencing complications. 7Notably in subcontinental Asia, half of all skincare industry spending is dedicated to fairness creams. 8With the rising prevalence of international travel, migration, and e-commerce, these patients may present to physicians anywhere.It is crucial for physicians to be aware of these trends and the complications that may arise from fairness cream usage Table 1.Our research aims to understand the information presented in fairness cream commercials, specifically how it persuades and influences consumers to use fairness creams.While prior research recognizes advertisements as the primary influence for using fairness products, we have not come across any study that analyzed these advertisements.Analyzing commercials will unveil the strategies that companies employ to influence consumer behavior, particularly regarding highlighting specific ingredients.It will be interesting to explore which ingredients are emphasized and which are avoided due to negative connotations, providing valuable insight into advertisement practices of fairness creams.Table 2.

| ME THODS
Two search strategies were devised to explore fairness cream commercials on YouTube from countries in subcontinental Asia (India, Pakistan, Bangladesh, Sri Lanka, and Nepal) during the period of April to May 2023.The first strategy involved entering the search query "fairness cream" or "lightening cream" or "whitening cream" followed by the name of the specific country on YouTube.For the second strategy, we searched Google for the popular fairness cream in each country and then used the cream's name to search for related commercials on YouTube.All videos were searched on YouTube regardless of their upload year or date of production.
To minimize the risk of bias, we conducted the searches in incognito mode.We carefully selected eligible YouTube videos that were television advertisements specifically promoting commercial fairness creams.These selected advertisements were then analyzed by individuals who were proficient in understanding the language in which they were recorded.
During the analysis, we recorded various variables from the commercials, including the country of origin, runtime, number of views, year of upload, brand name, target gender, involvement of celebrities/athletes/doctors, mentioned ingredients, use of specific keywords like fairness, white, lightening, bright, or glow, and whether the commercials depicted the user overcoming hurdles or difficulties after using the cream.

| RE SULTS
A total of 189 fairness cream commercials were initially identified on YouTube.After excluding duplicates, commercials from nontargeted countries, and commercials in languages that were not understandable, a total of 152 fairness cream commercials were included in our data analysis.These commercials were selected from five countries in the Indian subcontinent, namely India, Pakistan, Bangladesh, Nepal, and Sri Lanka.Among the included commercials, 68 (44.74%) were from India, 46 (30.26%) from Pakistan, 21 (13.82%) from Bangladesh, 7 (4.61%) from Nepal, and 4 (2.63%) from Sri Lanka.Commercials from a total of 25 different brands were included in our study.
The average runtime of the commercials was 26.6 s, with the longest commercial being 90 s and the shortest being 10 s.The commercials were uploaded on YouTube between 2010 and 2023.Out of the analyzed commercials, 128 (84.21%) targeted female consumers, while only 24 (15.79%)targeted male consumers.Celebrities were featured in 118 (77.63%) commercials, and in 5 (3.29%) commercials, both celebrities and doctors were involved.For the remaining commercials, it was not possible to determine if celebrities were used or not.
The commercials were assessed for keywords such as fair, white, light, bright, and glow.Individually, the term "fair" was used in 117 (76.97%) commercials, "glow" in 48 (31.58%), "white" in 13 (8.55%),"light" in 4 (2.63%), and "bright" in 15 (9.87%) commercials, either verbally or visually.A significant amount of commercials utilized more than one keyword.For example, fair and glow were used together in 25 (16.45%)commercials, bright and glow in 8 (5.26%), fair and bright in 7 (4.61%),bright and light in 2 (1.32%), fair along with white was used in 1 (0.66%), white along with light in 1 (0.66%), and white and glow in 1 (0.66%).Specific ingredients were mentioned in 72 (47.37%) commercials, with vitamins being the most commonly mentioned (41 commercials).Furthermore, 83 (54.61%) commercials depicted individuals overcoming hurdles or difficulties after using the fairness creams.These commercials showcased improved performance in work or sports after applying the creams.During our analysis, we observed that the majority of videos were uploaded in 2021 (21 videos).Of note, we also noticed that one prominent global fair cream brand underwent rebranding in 2021, replacing the word "fair" with "glow."By analyzing the distribution of commercials by upload year we can see a rise in the number of commercials in recent years.Based on the findings, there is a predominantly female-oriented marketing approach employed by these commercials, with a significant majority targeting female consumers.This aligns with the cultural emphasis on fair skin as a desirable trait for women, which further perpetuates the beauty standards associated with fair skin.
The concomitant use of celebrities in a substantial number of commercials also indicates the influence of popular figures in endorsing these products and promoting their benefits.
According to one study, "Media/TV/Advertisements" were the primary influence for using fairness products, followed by "Friends" and "Family". 6,7Nearly half of the respondents (44.6%) attributed their use of fairness products to media, television, and advertisements. 6,7In this study, it was also identified that women were significantly more likely to report side effects compared to men. 6,7is could be attributed to the proposition that women tend to use fairness products for longer periods of time, suggesting a potential relationship between duration of use and adverse effects. 6,7Within the group of current users, a significant minority (17%) reported experiencing adverse side effects.This finding is alarming from a public health perspective, especially considering that the market lacks regulations for these products and their ingredients.Moreover, even if a single use of a product may be considered "safe," regular, and prolonged use of certain skin fairness products can lead to the accumulation of harmful chemicals in the liver and kidneys, potentially contributing to organ damage.
The impact of fairness cream usage and popular media stigmatization extends beyond the subcontinental Asian populations.In Africa, the media also plays a crucial role in shaping the purchase and usage of skin lightening products. 8,9Specifically, women have expressed that the way these products are advertised on television compels them to prefer lighter skin tones. 8,9The desire to lighten one's skin is influenced by various biopsychosocial factors, and insecurity and low self-esteem may play significant roles in driving individuals to engage in skin-lightening practices.These findings highlight the complex interplay between societal influences, personal psychological factors, and individual choices in the usage of fairness creams. 8,9Understanding these dynamics is essential for addressing the underlying issues and promoting positive body image, self-acceptance, as well as cultural diversity.
Fairness cream commercials, with their emphasis on lighter skin as a beauty ideal, can have far-reaching effects on both adults and children.When children are exposed to these commercials, they may internalize the message that fair skin is superior, leading to negative body image and self-esteem issues.Also, the health consequences of fairness creams, such as the presence of harmful ingredients like hydroquinone, mercury, and corticosteroids, can pose significant risks to children's health if they are exposed to these products at a younger age, or used for a longer period of time.It will be essential to regulate fairness cream advertisements and focus on educating parents and children about the potential dangers associated with these products in order to protect their health and promote cultural awareness and sensitivity.Limitations of our study include its focus on video commercials from South Asian countries available on YouTube.Future research directions could include a global assessment of modalities used to advertise fairness products.This would help the consumers as well as the dermatologist better understand the strategies employed to target consumers.This knowledge can empower dermatologists can better guide their patients.
In a study related to skin lightening, 53.8% of respondents believed that lighter skin contributes to higher self-esteem, and 51.9% of respondents believed that lighter skin looks beautiful and healthy. 10Furthermore, respondents also believe that having light skin could increase the chances of getting married and securing a better job. 10 This perception could be attributed to the influence of advertisements, as majority of them depict that people become more successful after using fairness creams.Previous research highlights that insecurities developed in early age tend to persist and manifest as a person ages. 11These advertisements try to promote hegemonic beauty standard such as white, thin, young, and hyperfeminine female. 11When children are exposed to these commercials, they may internalize the message that fair skin is superior, leading to negative body image and self-esteem issues.These advertisements create unrealistic, artificial beauty standards that may lead to lower selfesteem and negative body image in individuals who do not conform to these hegemonic beauty standards.
It is crucial for dermatologists to provide guidance and counseling to patients who express a desire for fair skin.While societal beauty standards may promote the idea that fair skin is more desirable, it is essential to emphasize that healthy skin is beautiful skin.
Dermatologists can educate patients about the potential risks and adverse effects of using fairness products, such as the presence of harmful ingredients and the potential for skin damage.By promoting a holistic approach to skincare and emphasizing the importance of self-acceptance and self-care, dermatologists can help patients achieve and maintain healthy, radiant skin.This will, in turn, lead to increased self-esteem and positive body image.

| CON CLUS ION
The

AUTH O R CO NTR I B UTI O N S
Each author contributed significantly to the conception, design, data collection, analysis, and writing of the manuscript, ensuring a collaborative effort in the completion of this research.

ACK N OWLED G M ENTS
We would like to express our sincere gratitude to all individuals and institutions whose support and contributions made this research possible. Figure.1.

1
Distribution of commercials by the upload year.
advertised bleach, five (3.29%) commercials advertised peptides and four (2.63%) commercials advertised rose serum as its ingredients during commercials.None of the commercials advertised hydroquinone or corticosteroids as their ingredients.Six commercials (3.95%) depicted that ordinary fairness creams can be harmful to the skin and portrayed their fairness cream ingredients to be better and claimed that their fairness cream would not cause adverse effects.4| DISCUSS IONTo the authors' knowledge, this is the first study that analyzes the content of fairness cream commercials-the primary influence persuading consumers to use fairness creams.Through our analysis of these commercials, we provide insight into the tactics employed by companies to market their products.This understanding will empower dermatologists to better educate their patients/consumers about the adverse effects of fairness cream, which in turn curtail the usage of fairness cream.Our results highlight that the majority of these commercials feature celebrities, target a female audience, and use keywords such as fair, glow, and bright.The findings of this study provides valuable insights into the prevalence and characteristics of fairness cream commercials in India, Pakistan, Bangladesh, Nepal, and Sri Lanka.The significant number of fairness cream commercials on YouTube demonstrates the high prevalence of these products in the cosmetic industry and their popularity among consumers in the region.Based on the findings, commercials from India constituted the largest proportion, followed by Pakistan, Bangladesh, Nepal, and Sri Lanka, indicating the widespread use and demand for fairness creams across different countries within the subcontinent.
prevalence of fairness cream commercials on YouTube and the high demand for fairness creams in subcontinental Asian populations highlight the cultural significance placed on fair skin.However, the use of these products comes with potential significant risks and adverse effects.Active ingredients such as hydroquinone, mercury, and corticosteroids, which are commonly found in fairness creams, can lead to cutaneous manifestations, systemic health complications, and endocrinologic imbalances.The predominant targeting of female consumers and the involvement of celebrities in these commercials further perpetuate the beauty standards associated with fair skin.It is important to recognize the broader implications of fairness cream usage beyond subcontinental Asian populations.The media plays a significant role in shaping the usage of skin lightening products globally, and the desire for fair skin can be influenced by various biopsychosocial factors.Media advertisements promoting fair skin contribute to the popularity and demand for these products, but also perpetuate negative body image and self-esteem issues.Dermatologists play a vital role in guiding and counseling patients who desire fair skin.By promoting a holistic approach to skincare, emphasizing the importance of self-acceptance and self-care, and educating patients about the risks and adverse effects of fairness products, dermatologists can help individuals achieve and maintain healthy, radiant skin while challenging societal beauty standards.
Content of Top 10 most viewed fairness cream commercials in our study.