Inside her tiny room, 17-year-old high school student Chim Srey Neat pulls a large rectangular plastic box out from under her bed. Contained within is enough skin-whitening cream to last her for one year, with three applications per day. Sitting on her pink bedspread, she opens the lid and starts to dab the light orange substance onto her forearms.
“Dark skin is not popular among young Khmer people. I would like to be different from the others,” confides the bleached-blonde. “I use whitening cream because it makes me feel brighter, younger and more attractive.”
In Phnom Penh, skin-whitening creams are popular with students, models and even monks, flying off the shelves of grubby market stalls and pristine shopping malls alike. But the insufficiently regulated market, and a lack of awareness about the risks, has proven to be a dangerous combination.
Depending on the brand, skin-whitening creams can contain a variety of chemicals, including exfoliating compounds, plant extracts, corticosteroids and vitamins. Some act as skin peeling treatments while many are intended to treat serious skin disorders like moles, eczema, dermatitis and psoriasis.
After several months of application they can moderately bleach a person’s skin – but they can also result in severe, and in some cases fatal, health problems.
Chim Srey Neat started using the cream two months ago, after buying some at BKK market on street 380. Creams there range in price between $2.50 and $3.00, and Chim Srey Neat opted for the most expensive brand. She uses it in conjunction with creams supplied by her doctor, and under the supervision of her aunt, who works in a beauty salon.
The profit to be made from selling skin-whitening creams has drawn storekeepers, beauty
salons and even some dermatologists to sell homemade concoctions, without any quality control.
In Central Market, a shopkeeper recommends a fast-acting skin-whitening cream. The woman points to a rabbit-shaped plastic box – a base cream from Thailand that costs only $1.00. She moves other coloured tubes of cream to the counter, with names written in Thai, Vietnamese and Chinese.
To these she adds powders wrapped in delicate flower paper and several pink pills. The whole lot would set a customer back just $20.
“I know the quantities, I have learnt the recipes from another skin cream seller,” she says reassuringly.
Siv Vouch, 45, a pharmacist with the Drug and Food Department (DDA) of the Ministry of Health, said that Cambodia follows ASEAN guidelines for manufacturing the cream, but added that there could always be dangerous products brought in illegally from overseas.
“Our ministry is not responsible for all of the products. We can’t control everything because some companies … import these products illegally, mostly from Thailand,” she said.
Locally made skin-whitening products are certified by the DDA, and carry a sticker bearing the code CAMN1976CN-11, (with the last two digits indicating the year). Prior to gaining approval from the Ministry of Health and the Ministry of Trade, manufacturers also have to sign a form stating what ingredients they will use and confirming no illegal substances will be included.
But Siv Vouch admits that the Ministry of Health has not yet attempted to engage with the wider consequences of skin whitening. There are no advertising campaigns, posters or booklets warning of the substantial health risks.
At Calmette Hospital, dermatologist Thav Sothavy sees the consequences first-hand, every day.
“More than half my patients come for problems caused by whitening creams,” she says. “All whitening creams are dangerous, especially the mixed creams. Those creams can contain corticosteroids, antibiotics, molecules such as hydroquinone, which is carcinogenic, or even mercury salts that are highly toxic, mixed with Vaseline.”
She says the side effects from applying these substances can range from allergies, scars and eczema to severe and non-reversible pigmentation troubles and can even promote the onset of autoimmune skin disease.
As Thav Sothavy lists the dangers of skin whitening, a young man in a saffron robe enters her office. He asks for a consultation to treat acne and eczema – symptoms which were caused by his use of whitening cream. His name is Soung Sophorn, and he is an 18-year-old Buddhist monk.
Soung Sophorn said that skin-whitening creams are popular in his pagoda, despite the Buddhist predilection for avoiding such Earthly concerns.
That skin-whitening cream has spread even to monasteries would not surprise Thay Kea, 57, a dermatologist at the Phnom Penh Skin Clinic. He calls the skin whitening trend a “plague” and likens it to
“At the beginning, the user feels very comfortable. But after long-term use … it becomes painful [and leads to] itching and burning,” he says.
“It’s just like with alcoholics or drug addicts. I explain the risks to the patients, I give them counselling, but they have to make the decision to stop [using the cream].
And for them, it’s hard. I see many people returning to me because they have plunged back.”
In the worst case scenario, people who use the creams could end up like Chhuon Sovann, a 23-year-old woman from Poipet who died last year after reacting violently to a skin-whitening cream.
But her cautionary tale struggles to be heard amid mass media glamourisation of pale skin.
“There is a dominant white model,” declares Dr Ly Cheng Huy, 40, a beauty expert who runs Health Magazine and the website HealthCambodia.com. “In Cambodia, the reasons are cultural: white people were people who [didn’t go] outside, people who didn’t work; the rich people. For women, beauty [equates] with wealth and love. Women don’t want to work. They think that [with] white skin, they can find a rich husband.”
On television, Ly Cheng Huy is a vocal campaigner against whitening creams and also plans to create an independent scientific committee to regulate standards. But when asked why the front-page models on his magazine are all pale, he becomes slightly embarassed.
“It’s a good question,” he says. “The photo studio wants women with clear skin. At the beginning, we tried to publish a picture of a dark-skinned woman,” he says, brandishing the cover of an old copy with a golden brown Khmer model. “But sales were poor and all the models here whiten their skin.”