A Systematic Review and Narrative Synthesis of Associations Between Education and Use of and Knowledge About Skin Bleaching and Skin Lightening Products

Skin bleaching and skin lightening (SBSL) practices are globally prevalent and driven by colorism, beauty ideals, and perceptions of social advantage. Despite well-documented health risks linked to toxic ingredients like mercury and hydroquinone, use remains widespread. This systematic review examines the role of general education and specific product knowledge in influencing SBSL behaviors across global contexts. Following PRISMA guidelines, 38 studies published between 2014 and 2024 were reviewed from PubMed, WoS and Google Scholar, focusing on awareness, knowledge, attitudes, and practices related to SBSL. Findings indicate that while higher educational attainment often increases awareness of SBSL-related health risks, it does not consistently lead to reduced use. Cultural and social pressures such as peer influence, beauty standards, and economic motivations frequently override the influence of education. In contrast, specific knowledge about harmful ingredients appears more closely linked to cautious use, though misconceptions persist even among educated groups and healthcare providers. Geographic gaps in the literature persist, with most studies conducted in Africa and Asia, and minimal research in the Americas and Europe. These findings suggest that education alone is insufficient to drive behavior change. Effective public health responses must incorporate culturally sensitive strategies, improved product regulation, and targeted messaging about ingredient risks. More research is needed to assess which interventions can successfully reduce SBSL use and its associated harms across diverse settings.