HSINCHU, Taiwan — Walking along a rushing stream in Hsinchu, Hilda Chu balanced an umbrella in one hand and textbooks in the other. Her skin was ghostly white. “I try hard to make my skin white,” said Chu, 18, a student at National Tsing Hua University. “If my skin is lighter, I will be happier because I think I look good. It makes my emotion better, yes.”

She's hardly alone. Asians spend an estimated $18 billion a year to appear pale.

“Asians like white skin," said Dr. Hsieh Ya Ju, a dermatologist at MacKay Memorial Hospital in Hsingchu, who sees about 25 patients a day. Outside Hsieh’s office, four middle-aged chalky-skinned women sat patiently awaiting treatments that cost $300 to $500 per session. They are there to take pills that Hsieh says will help their skin turn white. Doctors in Taiwan also use lasers, creams, surgeries and other means to lighten skin.

Nydia Lin, a senior executive in Taiwan for Japanese cosmetics giant Shisedo, said as many as 50 percent of Taiwanese women (and growing numbers of men) are paying big money to medically alter their golden exteriors. “We promote the idea of whitening. Especially in Taiwan we see many beautiful idols on TV and they are all focused on their whitening skin. As the Chinese say, ‘You can cover all your defective parts if you are white.'”

Variations of that slogan are heard throughout Asia, with the most common translation being, "One white can cover up three ugliness.” According to a 2004 study by global marketing firm Synovate, nearly 40 percent of women in Taiwan, Hong Kong, South Korea, Malaysia and the Philippines used skin whitening and lightening products that year.

Asian skin whitening has a tradition that stretches back centuries. "The feminine ideal during the Han period for women of the court was almost unearthly white, white skin. Moon-like roundish faces, long black hair. You can see how a culture that maintained that as an early ideal might continue with an ideal that light skin equals beauty," said Anne Rose Kitagawa, assistant curator of Japanese art at Harvard’s Sackler Museum.

Asia’s obsession with whiteness is also a reflection of economic status. "Those who had skin burnt by the sun were working in the fields, therefore, the whitening of the skin was a reflection of labor status,” said University of Houston historian Gerald Horne.

Horne also points to a political angle, shaped by the Allies' victory in World War II. “An aspiration of many in Asia toward whiteness is a reflection of the idea that the North Atlantic Powers were the quote — winners — unquote, and therefore they need to be imitated.”

But Chao-uan Tsen, of the Taipei womens' rights organization Awakening Foundation, said the whitening trend is a form of self hatred. “The beauty industries in Taiwan emphasize different skin tones and say that if you can be as white as Japanese women you can be as beautiful as a cherry blossom. This kind of image which they create doesn’t make women any happier. It actually creates more anxiety.”

Moreover, there are medical downsides to seeking lighter skin. That's especially true for those who can't afford expensive treatments, such as poor women using illegal bleaches and creams containing mercuric chloride that have left them disfigured.

Skin whitening can be dangerous for other reasons too, including the loss of melanin. “The whiter they become the more chances they will be subjected to skin damage and skin cancer," said Dr. Ernesto Gonzalez, director of international dermatology training at Boston’s Massachusetts General Hospital.

Medical concerns aside, Taiwanese student Hilda Chu views skin whitening as a practical response to society’s pressures: “My future employers like white skin more,” she says simply.

Editor's note: The caption of the photo on this story was changed to more accurately reflect the photo.