Flyers put out by the Minnesota Department of Health warn of the dangers of skin- lightening products that contain mercury. The information is written in different languages, including English, Spanish, Hmong and Somali. Credit: Christine T. Nguyen | MPR News

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Amira Adawe is on a mission to ensure those who are black and brown love the skin they’re in.

This week, the state recognized Adawe’s work and awarded her nonprofit, The BeautyWell Project, a $55,000 grant to continue educating communities of color about the negative health effects of using products to lighten their skin.

The grant was one of four allocated by the state Health Department to help communities begin to talk about the often taboo topic as a public health issue. The other recipients included the Minneapolis and Dakota County health departments, which received $90,000 and $10,000 respectively, and the Minneapolis-based, nonprofit Wellshare International, which was given $45,000.

The state received a dozen applications, with awards going to those that “had a broad range of reaching out to our diverse communities of color that are impacted by skin lightening,’’ said grant manager Michelle Gin.

The grant was funded by the Skin Lightening Products Public Awareness and Education Bill, which Adawe and Rep. Hodan Hassan, DFL-Minneapolis, spearheaded. It’s designed to provide money and resources for advocacy and education tied to skin lightening.

Adawe also took on Amazon last summer, leading to the online retailer removing 14 skin-lightening creams with toxic levels of mercury in them.

The issue is personal for Adawe, who is Somali.

“I’ve seen some of my family members use, friends use,” she said. “ I was always interested in wanting to learn about this issue.”

Her goal is to ensure skin lightening is not compartmentalized as a “communities of color” issue but is seen as a public health issue.

“This involves a lot of women and children who are getting exposed to a lot of chemicals that are not well addressed,” she said.

With her grant, she said she plans to develop a tool kit to educate immigrant parents on skin-lightening exposure, working with school clinics in the city of Minneapolis, and businesses on regulatory practices. She hopes to serve as a cultural liaison.

“This requires a lot of relationship building, a lot of the sensitivity of the language that we use when we educate people,” she said.

A blind spot

Eight years ago, Adawe put skin lightening on the Department of Health’s radar. She was doing research on skin-lightening products as a graduate student at the University of Minnesota School of Public Health. Through her work, the Department of Health began to focus in on the products. She asked them to start testing them for mercury.

In 2012, the department started its Family Environmental Exposure Tracking, looking into mercury, lead and cadmium in pregnant women — all chemicals that could be harmful to them and their fetus.

The state Health Department was originally only testing through blood samples. Adawe alerted the department to a potential cultural blind spot, said Jessica Nelson, program director of the Department of Health’s biomonitoring.

“In addition to eating certain kinds of fish that are high in mercury, Amira pointed out to us, there’s an additional important source of mercury exposure in communities in our state, which is potential exposure to skin-lightening products,” Nelson said.

The Health Department then began testing urine, which would better indicate mercury due to the use of some skin-lightening products. The department tested 779 women of various ethnicities. Hmong women tested the highest for the level of mercury. East African women tested the second highest.

According to the World Health Organization, mercury can have adverse effects on the nervous system and the kidneys.

Dr. Charles Crutchfield, an Eagan-based dermatologist, has had many patients come through his office looking to treat dark spots or lighten their skin. Sometimes patients need to repair the damage done by use of the products, he said.

“I see this on a regular basis, on a daily basis,” he said.

Crutchfield said one of the chemicals typically found in skin-lightening products that may have adverse effects is hydroquinone, a depigmenting agent that decreases the formation of melanin in the skin.

“You can only use it for a short period of time. If you use it for too long, it’ll actually do the opposite. It makes your skin darker,” he said. “You see a lot of patients who say their skin is now stained or damaged and because they’ve used a product way too long.”

‘Just in our culture’

Skin-lightening products can be found online with a quick Google search, but many can be found at some local ethnic stores and businesses throughout the state.

It’s big business. According to Grand View Research, the global skin-lightening products market size was valued at $8.3 billion in 2018.

In the Hmongtown Marketplace, an indoor/outdoor flea market in St. Paul, traditional Hmong clothes hang from one booth, and across the hall, eyelashes and lip gloss line a table. The aroma of laab juxtaposes the milky boba tea.

Like many other ethnic stores across the state, skin-lightening products have become a staple. A woman with porcelain skin adorns some of the packaging.

Jamison Liu, manager of the marketplace, said he was unaware some of the products have tested positive for high levels of mercury.

“You look at the packaging and it’s very nice. It looks very legit, you never think that some of the products overseas, they would fill it with mercury,” Liu said.

Liu said the skin-lightening cosmetics that contain toxic levels of mercury are illegal, but the products are not closely regulated by the Food and Drug Administration and are still fairly easy to get hold of. With the state Health Department, Liu worked with his vendors to have the products removed from the market and educated them on the dangers.

Liu and his management team even passed out informational flyers to customers with the message “love your skin” and information on the side effects of mercury last year. He said, the skin-lightening products vendors have sold in the past are products that they’ve seen in their home countries.

“It’s kind of hard because it’s almost like a cultural clash. There are certain products that they’re used to in Thailand or Laos that they don’t realize that there are harmful effects,” Liu said.

Nafisa Mohamed also knows how deeply ingrained the skin-lightening products are in her Somali American culture. The 36-year-old college student used to work in Karmel Mall, a Somali shopping center in Minneapolis. She said skin-lightening creams were just part of the norm.

“My whole life I’ve been around it or experienced it, I have relatives who have used it, I’ve tried to use it. To be honest, it’s just in our culture,” she said.

Taboo topic, products date to 1800s

What’s the allure?

Similar to the Hmongtown Marketplace, the products are seen in every few stores in Karmel Mall. Many vendors didn’t want to talk. One vendor who sells natural skincare products said skin lightening is bad for the community, but worried that saying it publicly would lead to pushback from others.

From shopkeepers to shoppers, the reason people buy the products is the same: a quest to attain an unrealistic beauty standard.

“It’s the same thing like being brainwashed and being colonized, the fact that if you’re lighter you’re prettier,” Mohamed said.

Ronald Hall, a social work professor at Michigan State University and the author of “The Bleaching Syndrome” said whiteness as the standard of beauty cuts through all cultures. Lighter skin is idealized as the standard of beauty and has societal benefits.

“There’s a very practical element in light skin, you get more education, you get better incomes, and you get more occupational prestige,’’ he said. “So, aside from the beauty that’s involved you also have a quality-of-life issue.’’

He said the beginning of skin-lightening products dates to the late 1800s.

The creams “were not advertised to brighten or lighten your skin. They were marketed as a cream that would even your skin tone,” he said. “African Americans were kind of embarrassed to admit publicly that they aspire to lighter skin.”

That conditioning is deeply ingrained, he added.

Colorism, or discrimination based on skin color, takes a greater toll on women, especially when it comes to desirability, he said.

“Light skin, in particular, represents the feminine ideal regardless of what your race or ethnic group is. So women of color have tried to increase their value, particularly their marketability in marriage, by approximating light skin.”

Redefining ‘beauty’

One of the hardest parts of addressing the issue is getting people to talk about it. Adawe has a talk show on KALY, a Minneapolis-based Somali language radio station, where occasionally, some women call in and talk about using the products under anonymity.

Rarely do women admit to using the products. Hall said there is a sense of shame attached to it.

“It’s very painful and it can be very easily construed as self-hate,” he said.

The centuries of racial trauma make it hard to reverse. Adawe believes the real work going forward is undoing that twisted standard of beauty.

“How do we undo or decolonize people’s minds to not change their skin color? How do we create environments that are welcoming? That’s accepting everybody regardless of the skin color that they have?

“How do we redefine beauty standards?” she said.