Specific zones of abnormally high pigmentation such as moles and birthmarks may be depigmented to match to the surrounding skin. Conversely, in cases of vitiligo, unaffected skin may be lightened to achieve a more uniform appearance.[1][medical citation needed] Long term use of skin whiteners can lead to pigmentation increasing to the joints of the fingers, toes, buttocks and ears. The skin of the face can become thinned and the area around the eyes can have increased pigmentation causing a 'bleach panda effect'.[2]
2012 sales of skin lightening creams in India alone totaled 258 tons[3] and the global market for skin lighteners is projected to reach US $19.8 billion by 2018 based on sales growth primarily in Asia, Africa and the Middle East.[4]