Oscar-winner Lupita Nyong’o’s heartfelt speech on beauty, delivered at the seventh annual Black Women in Hollywood luncheon hosted by Essence magazine in February 2014, moved many to tears. If you’re not familar, during the speech, Nyong’o shared a letter she received from a girl who decided against lightening her skin after Nyong’o “appeared on the world map and saved me.”Who hasn’t admired the actress’s gorgeous dark skin (which looks amazing against every color in the rainbow) and radiant smile?

The graceful and talented Nyong’o has created waves everywhere, but even so, there are corners of our world where people have no idea that she has become the new icon for black beauty. Yetunde Mercy Olumide, emeritus professor of medicine at the University of Lagos in Nigeria, and a consultant physician, dermatologist and genitourinary physician, for instance, would wager a bet that on the streets of her hometown, few have any inkling as to the furore Nyong’o and her speech have created.And yet Nigeria is one of the countries most affected by the key issue Nyong’o raised in her speech: the ever-present desire so many dark-skinned women have to be light.

In Nigeria and elsewhere in Africa, but also in India, the Caribbean, and Asia, this pernicious desire is deeply ingrained in the national psyche. Beauty standards and perceptions aside, “the social aspect of self-image and acceptance are all associated with lighter skin,” says Lester Davids, molecular cell biologist in the department of human biology at the University of Capetown in South Africa. “The idea is that with lighter skin, you’ll get a better job, a better life, partner, income, etc. All those aspects are quite rife still within the psyche.”

Why African Women Bleach

Researchers pinpoint Apartheid-era South Africa as a major driver in the quest for lighter skin in that country and across Africa. Read more about the social history of skin lightening here.

Undoing the complex layers of history and social mores upon which the desire for lighter skin is based is no easy feat, but for scientists like Davids and medical practionners like Olumide, the greatest and most pressing problem associated with the quest for lighter skin is the widespread usage of skin-whitening creams in their countries and in other parts of Africa—a craze that often has disastrous and even dangerous consequences and for the time being, shows little signs of abating.

“Right now, I will tell you that the usage [of these creams] is on the increase,” Olumide says.According to the World Health Organization (WHO), 77 percent of Nigerian women—the highest percentage in the world—use skin-lightening products on a regular basis. Usage is sky-high in South Africa, too, and in both countries, as well as in other parts of Africa, it’s fueled by the widespread availability of a plethora of cheap, purported skin-whitening products. Many of these are homemade, Davids says, but others flood in across the borders from various African nations, as well as from India and Japan.

“It doesn’t take long to copy a cream from a big cosmetic house that promises to remove dark spots, pigmentation, etc., and sell it at five or 10 times cheaper for a much poorer market,” Davids says. “The problem is that a lot of these creams have been tainted because of chemicals and compounds added in unscrupulously without a scientific base.”

While the wealthier segments of African society can afford to buy better quality, properly regulated products, and can avail of dermatological guidance for their proper usage, the lack of education that prevails in many nations on that continent, coupled with the overarching goal of lightening the skin, results in a gross abuse of cheap creams, and the disastrous consequence of this, Davids says, is one of the biggest problems Africa as a whole faces today.

Medical disasters

Skin-whitening creams contain three main ingredients: hydroquinone, a phenol that lightens the skin by inhibiting the enzyme that generates color and also aids in evening out the skintone; corticosteroids that slow down and reduce the number of pigment cells; and mercury, which inactivates the enzyme that leads to the production of melanin.In the U.S., their usage is strictly regulated: No over-the-counter cream can contain more than 2 percent hydroquinone, for example, and any cream with more than that concentration must be prescribed by a dermatologist with specific guidance to be used for limited time only.In Africa, however, there are no strict controls on the composition of skin-whitening creams.

Worse, “a layperson will take the cream and put it on their skin and see it works and even if they’re told they have to put it just once a day, they think that if you put on more it will work faster and do more,” Davids says. “So people slap the cream on 10 times a day and it does work effectively, but the concentration of the compound becomes toxic to the skin and toxic to the cells.”Prolonged usage of these creams irreversibly damages the skin. Not only do the hydroquinone and corticosteroids in the creams kill the pigment-producing cells, the rest of the compound actually activates other cells to produce more pigment. The result: A blotched, uneven complexion that’s a far cry from the desired result.

Fighting Skin Bleaching in Africa

An anti-skin-lightening activist in Ghana is successfully reaching rural villages with her message that dark skin is beautiful.

Read her story here.

In fact, the prolonged usage of any skin-lightening cream, even if its hydroquinone content is at or below the prescribed level, can result in exogenous ochronosis, or a permanent darkening of the skin. But prolonged usage of these creams in developing economies has even more dire consequences, since strong corticosteroids thin the skin out and large amounts of mercury will eventually be absorbed into the blood stream, and can result in brain, gastrointestinal and kidney problems.

“In our countries, women bleach all over the body and this thins the skin to such an extent that wounds don’t heal properly after surgery, so a C-section or a fibroid operation or a tummy tuck don’t heal, and ruptured incision wounds lead to severe infections and death,” Olumide says.

Grassroots Education

In her speech, Nyong’o confessed to skin-lightening pressures she herself has felt. She attributes her confidence in her appearance to the trailblazing South Sudanese British model, Alek Wek.

That kind of strong message is extremely important for Africa, Davids says, and can go a long way toward altering the psyche and, eventually, toward minimizing the usage of lightening products. But for now, voices like Lupita’s are loudest in the West, Davids believes, since the celebrities who stand out in Africa are either light skinned themselves or, like Nigerian-Cameroonian pop singer Dencia, whose cream “Whitenicious” was a sellout hit, they actually further the idea of skin whitening. In fact, even ads for products that have nothing to do with skin lightening tend to feature people with lighter skin.

No Skin-Bleaching Models Allowed

Meet the fashion designer taking a stance against skin lightening—she won’t use models who bleach their skin.

Read her story here.

What’s needed in Africa is a concerted, all hands on deck approach, Olumide says, beginning with education at the grassroots level on the dangers of using skin-lightening creams, and including doctors, scientists, governments and corporations. Organizations like the Medical Women’s Association of Nigeria have taken this up as their cause, she says, and “we have medical students who have a health week and go to markets and enlighten people on bleaching cream.”

There is a lot of work to be done, but “I am hoping that we will get there, that we will become proud of our skin color, and we should because we are not under racial pressure,” she says. “We are just doing what we are doing and skin lightening has become a vicious circle.”Watch Lupita Nyong’o’s moving speech here: