It starts when children are young. The moment a child is born, relatives start comparing siblings’ skin colour.

It starts in your own family. But people don’t want to talk about it openly.” Kavitha Emmanuel is the founder of Women of Worth, an Indian NGO that is standing up to an ingrained bias toward lighter skin. The Dark is Beautiful campaign, launched in 2009, is not “anti-white,” she explains, but about inclusivity — beauty beyond colour.

It carries celebrity endorsement, most notably the Bollywood actor Nandita Das. A blog provides a forum for people to share their personal stories of skin colour bias. And the campaign runs media literacy workshops and advocacy programmes in schools to convey messages of self-esteem and self-worth to young children.

This is to counteract what Emmanuel says she has seen even in school textbooks, where a picture of a fair-skinned girl is labelled “beautiful” and a darker one “ugly”.

“Some children are really shocked that this is something that has affected them so intensely. Some are in tears,” Emmanuel says.

The perfect life from perfect skin: a life that’s only bestowed upon those of the right shade — that’s the message, the attitude and the mindset that’s being passed down. It has spawned a multibillion-dollar industry, encompassing not just cosmetic creams, but invasive procedures such as skin bleaching, chemical peels, laser treatments, steroid cocktails, “whitening” pills and intravenous injections —all with varying effectiveness and health risks.

It’s more than a bias; it’s a cultural obsession, and one that’s becoming dangerous. Multinational cosmetics brands have found a lucrative market — global spending on skin lightening is projected to triple to US$31.2 billion by 2024, according to a report released in June 2017 by the research firm Global Industry Analysts. The driving force, they say, is “the still rampant darker skin stigma and rigid cultural perception that correlates lighter skin tone with beauty and personal success”. “This is not bias.

This is racism,” says Sunil Bhatia, a professor of human development at Connecticut College. Bhatia has recently written in US News & World Report about “deep-rooted internalised racism and social hierarchies based on skin colour”.

In India, these were codified in the caste system — the ancient Hindu classification that determined occupation and social stratum by birth.

At the top, Brahmins were priests and intellectuals. At the bottom, outcastes were confined to the least desired jobs, such as latrine cleaners.

Bhatia says caste may have been to do with more than occupation —the darker you looked, the lower your place in the social hierarchy. This preference for fair skin was perpetuated and strongly reinforced by colonialism — not just in India but in dozens of countries where a European power established its dominance. It’s the idea that the ruler is fair-skinned, says Emmanuel.

“All around the world, it was a fact that the rich could stay indoors versus the poor who worked outside and were dark-skinned.”

The final wave of influence is modern-day globalisation.

“There is an interesting whiteness travelling from the US to malls (in other countries) featuring white models,” Bhatia tells me. “You can trace a line from colonialism, postcolonialism and globalisation.”

Western beauty ideals, including fair skin, predominate worldwide. And with these ideals come products to service them.

Skin-lightening agents are banned in Ghana, South Africa, the Ivory Coast and the European Union because their main ingredient, hydroquinone, is a potential carcinogen — yet they are still used illegally.

But the largest and fastest-growing markets are in the Asia-Pacific region. In India, a typical supermarket will have a wall of personal care products featuring “whitening” moisturiser or “lightening” body creams, from such recognisable brands as L’Oréal, Revlon, Pond’s and Neutrogena. Pooja Kannan, a 27-year-old from Mumbai, spent years buying cosmetics that promised to lighten her complexion.

For a while she put her faith in the cream, face wash and soap from Fair & Lovely, India’s oldest brand for treating “skin fairness problems”. During her last two years of college, she switched to Pond’s Flawless White cream.

She used the products sparingly, since buying new ones still cost her Rs 200 or 300 every two months — equivalent to a week’s worth of travel to her college campus. Over four years of use, she tells me, her skin did lighten up a little, though she wonders whether that was due to the cream or her taking more care when going out in the sun.

Kannan’s natural skin tone looks a healthy light brown to me, but when she was growing up, her elder aunts would shake their heads in disappointment over her complexion. A tan would lead some relatives and classmates to admonish her.

“You’ve turned black,” they said. And in India, where skin tone often defines a person’s success in society and their ability to find work or a spouse, that sort of thing matters. Kannan says she brushed off her relatives’ criticism as being from a different generation, but her classmates’ comments made her feel insecure.

“It didn’t affect me right then, but when I was getting dressed up to go out, I would remember what they said and put on more make-up,” she says. “Especially when I was in 11th and 12th grades, there were two or three girls who would say these things a lot. They were trying to be helpful but to me it sounded condescending.

And it was hypocritical too, because it wasn’t like they were fair or beautiful or perfect themselves.” Society reminded Kannan of it too. She is a professional dancer, and says, “The prettier, skinnier and fairer girls are positioned at the front of the stage. That gets to you.”

This preference for fair skin is reinforced in movies, television programmes and especially advertising. German skincare company Nivea has faced accusations of racism for a Facebook ad targeted at customers in the Middle East, declaring “White is Purity”.

Last year, actor Emma Watson had to issue a statement saying she would no longer endorse products which “do not always reflect the diverse beauty of all women” after criticisms of her earlier appearance in ads in Asia for Lancôme’s Blanc Expert line, used for skin lightening.

The Advertising Standards Council of India attempted to address skinbased discrimination in 2014 by banning ads depicting people with darker skin as inferior but the products are still marketed. Ads for skin-lightening creams still appear in newspapers, on television and on billboards, featuring Bollywood celebrities such as Shah Rukh Khan and Deepika Padukone.

In multiple Facebook posts in April 2017, actor Abhay Deol called out several of his colleagues for endorsing fairness creams, following it up with an opinion piece in the Hindustan Times in which he wrote that “advertising preaches that we would get a better job, a happier marriage, and more beautiful children if we were fair”.

That said, skin lightening is not the sole preserve of the modern cosmetics industry. India’s traditional Ayurveda medical system teaches that pregnant women can improve their foetus’s complexion by drinking saffron-laced milk and eating oranges, fennel seeds and coconut pieces. In early 2017, an Ayurvedic practitioner in Kolkata led a session for expectant couples, promising that even dark-skinned, short parents could have tall and fair children.

And a 2012 study by a women’s health charity in India found that childless couples often insisted on and paid more for surrogates who were beautiful and fair, though the woman contributed no genetic material to the baby. Arguably, nowhere is the fair skin preference as ingrained as in classified ads placed in newspapers seeking a marriage partner.

Along with requirements for the prospective bride’s or groom’s caste, religion, profession and education, physical characteristics are also listed. Someone described as “dusky” may be skipped in favour of one who is of a “wheatish” complexion.

“Potential brides spend a lot of money; it’s really unlimited in the months before the wedding,” says Ema Trinidad, a Filipina beautician who runs a spa in Bengaluru. “I was so surprised when I came here that your chances of getting married depend on your skin colour. We don’t have that in the Philippines.”

She calls the Philippines “the skinlightening capital of the world” and thought she would specialise in anti-ageing treatments when she moved to India 11 years ago. But she soon realised that most of her clients had a primary request: lightening and detanning, particularly before weddings.

On the other hand, bleaching is a common treatment that lightens not the skin itself but the fine hairs on the face. Most skin-lightening treatments target the skin’s ability to produce pigment, or melanin, which gives your skin, hair and eyes their colour.

Everyone has about the same number of cells to make melanin but how much you actually produce is down to your genes. Darkerskinned people produce more. When exposed to the sun, the body produces more melanin to absorb harmful UV rays and protect skin cells.

And having more natural melanin also means that darker-skinned people tend to develop fewer wrinkles and are less at risk of skin cancer. Skin-lightening creams aim to interrupt the production of melanin and usually contain a natural ingredient such as soy, liquorice or arbutin combined with the medical lightening agent hydroquinone.

But these seemingly harmless cosmetics can carry risk. Another common ingredient in lightening creams and soaps, the World Health Organisation warns, is mercury. This suppresses the production of melanin, but it can also damage the kidneys and brain if it is absorbed by the skin and accumulates in the body.

In September 2016, the Food and Drug Administration in Maharashtra found mercury in five skin-lightening products manufactured by L’Oréal India, the country’s third-largest cosmetics company. Another common lightening method is a chemical peel, which removes the top layer of your skin. This leaves fresher skin exposed to harmful solar radiation and environmental pollutants. Laser treatments offer an even more aggressive approach by breaking up a skin’s pigmentation, sometimes with skindamaging results.

Mukta Sachdev, a clinical and aesthetic dermatologist in Bengaluru, recalls two cases of Indian men who came to her after undergoing laser treatments while working in South Korea. They were each in their late twenties and getting ready for marriages. One man developed redness on his face and the other had little white dots —“confetti-like” de-pigmentation.

Sachdev suspects the technicians in South Korea weren’t used to working with darker skin.

“You need to use less aggressive settings when doing laser. It’s very hard when losing pigmentation,” she says. She was able to treat the redness but the white patches remained despite her efforts to stimulate the pigment to return.

Many prospective patients come to her seeking skin lightening, but before offering them any treatment she counsels them to think less about light and dark and more about evenly toned, healthy skin.

“I’m trying to get away from this fairness obsession,” she explains. “Being hung up on dark skin can lead to low self-esteem and lower on the quality of life index.” India’s pharmaceutical regulator has approved at least 18 different corticosteroids for topical skin use, ranging from mild to super-potent.

These usually cost less than $2 a tube, and most pharmacies across the country will dispense them, even without a prescription. People apply them indiscriminately to treat pimples or for fairer skin, but steroid creams take off the protective outer layer of the skin so it is more exposed to UV rays and environmental pollutants such as smog and cigarette smoke.

But more worrying is that they can be addictive, says Shyamanta Barua, a dermatologist and honorary secretary general of the Indian Association of Dermatologists, Venereologists and Leprologists.

“The moment the patient stops using the cream, the skin reacts, gets irritated, develops rashes,” he says. “So the patient starts the cream again and it’s a vicious cycle. They become psychologically addicted.” He thinks users should be counselled as if they were addicted to recreational drugs or alcohol.

The dermatologists’ association is lobbying for topical steroid skin medications to be added to the Schedule H list, which would restrict their availability in pharmacies by requiring a doctor’s prescription.

They met with the Drug Controller General of India in March 2017, though Shyam B Verma, the dermatologist who heads these efforts, seems pessimistic as to whether any action would be forthcoming.

“These products are just a minuscule part of the overall drug industry, so it’s not a priority,” he tells me.

“Pharmacies dispense them like boxes of cookies. The drug companies know this is a drug and it’s not supposed to be used to lighten constitutive skin. But they label them with suggestive names like skin bright, skin light, skin shine, look bright.”

Furthermore, only around 35 per cent of pharmacies have a legitimate pharmacist on staff, so there is often no one to counsel the buyer on appropriate dosage and use of the cream.

Even worse, there are signs that improper steroid prescriptions — often in cocktails containing a mix of steroids, antibiotics and antifungals — may be fuelling a surge in bugs resistant to normal treatments.

And both physicians and pharmaceutical companies are at fault. Rajetha Damisetty, a cosmetic dermatologist based in Hyderabad, gives one example, Panderm +, which combines clobetasol, the most potent steroid known to man, with two antibiotics and two antifungals. “Only India has this crazy combination,” Damisetty says, and the result is a “nightmare”.

Normally, she says, “around 70-90 per cent of those affected by fungal infections would have used topical steroids for treatment and they would respond within two weeks. Now we have to give four times the dosage for eight to 12 weeks.

It’s an epidemic across the entire country.” The dermatologists’ association is trying to educate physicians, especially general practitioners who indiscriminately prescribe steroid creams, about proper prescriptions.

They are also engaging with pharmaceutical companies, which has borne some fruit — in April 2017, one company distributed flyers to 50,000 pharmacies warning “Steroids are potentially harmful. Do not use without a prescription.” But they’re fighting more than just bad medical practice or even consumer habits.

They’re fighting millennia-old preferences for lighter skin. Erasing those will require a change of mindset. This is perhaps easier to do in the young — after all, social signals about the value of fair skin begin as soon as they are born.

Emmanuel believes that people are more aware of the issue than ever before and hopes that the next generation will see things differently — not just in India but across the world.

In 2016, three students at the University of Texas, Austin, started an Instagram campaign called Unfair & Lovely — a play on India’s most popular fairness cream, Fair & Lovely. The #unfairandlovely hashtag invited darker-skinned people to share their photos. And in 2013, a young woman in Pakistan, Fatima Lodhi, launched the country’s first anti-colourism movement, called Dark is Divine. Lodhi has written about the prejudice she faced as a child, “I never got a chance to become a fairy in my school plays because fairies are supposed to be fair-skinned!” Now, she leads sessions at schools to make students more aware about skin colour discrimination.

Attitudes are already starting to change, especially among girls who are gaining confidence with education, employment and financial independence outside the home. Emmanuel tells me of one Dark is Beautiful session at an all-girls’ middle school in Chennai last January.

A dark-skinned teen — “stunningly beautiful but with deep self-esteem issues” — came up front. She was weeping because just that morning her brother had taunted her as “blackie”.

But Emmanuel was more surprised when another, lighter-skinned, girl stood up. She said she’d believed dark was ugly until that moment but apologised to her classmates with a promise to treat them better. “They all started clapping,” Emmanuel says.

“That’s a big move for a teenager. She really had the bigness of heart to say something like that.”