HEALTH KNOWLEDGE AND ATTITUDE REGARDING BLEACHING AGENTS IN WEST SAUDI ARABIA 107 beauty care agents and spend generously for it. Majority of women (77.4%) having an average income (from 500 to 5,000 USD) are keen to use TPAs. Bleaching products were used by 74.1% of the participants at least once daily. The monthly cost of the TPAs ranged between 5 and 2,500 SR (1.25–625 USD) (mean 136.4 ± 217.3 SR = 34.1 ± 54.1 USD). Thirty-seven women (13%) reported that they spent more than 200 SR (50 USD) per month on bleaching preparations. The amount of the bleaching creams consumed per month ranged between 1 and 800 g (mean 61.6 ± 98.5 g). More than one-third of the participants (35.3%) consumed more than 50 g of bleaching cream per month. In addition, 11.6% of women continued applying the TPAs throughout pregnancy whereas 20% did so during lactation. In Table II, more than one-third of women (39.6%) obtained these preparations from the pharmacy without prescription whereas 33.9% of them obtained these agents through prescription and 20.8% from beauty and cosmetic shops. The nature of the used agent was most frequently a mixture composed of a readymade drug at the pharmacy (37.8%) Table II Details of Using Topical Bleaching Agents Among Women Who Ever Used Them (n = 389) Questions Responses Frequency Percentage How did you obtain the cream?a Prescription 132 33.9 From the pharmacy without prescription 154 39.6 From herbal shops and open markets 62 15.9 Beauty and cosmetic shops 81 20.8 What is the nature of the cream you used?a Is composed of a readymade drug at the pharmacy 178 45.8 Mixture composed at the pharmacy 66 17.0 Mixture composed at herbal shops 44 11.3 Beauty product, non-medical 120 30.8 What is the reason behind the use? To heal pigmented areas like freckles 147 37.8 Just to lighten the color of the skin 80 20.6 Both of the above reasons 148 38.0 Others 14 3.6 Frequency of applying bleaching cream Once daily 160 41.1 Twice daily 108 27.9 Thrice times daily 20 5.1 Not daily 74 19.0 Others 27 6.9 Do you use bleaching creams during pregnancy? (n = 241) Yes 28 11.6 No 213 88.4 Do you use bleaching creams during lactation? (n = 235) Yes 47 20.0 No 188 80.0 Monthly cost of bleaching agents in SR (n = 285) 100 (25 USD) 185 64.9 100–200 (25–50 USD) 200 63 22.1 ( 50 USD) 37 13.0 Amount of cream you use monthly (g) (n = 119) 10 33 27.7 11–50 44 37.0 50 22 35.3 Age (years) at starting using bleaching cream (n = 354) 15 37 10.5 16–25 179 50.5 25 138 39.0 a More than one answer was allowed.

JOURNAL OF COSMETIC SCIENCE 108 or a nonmedical beauty product (30.8%). The commonest reported reasons for using these preparations were healing pigmented areas like freckles (75.8%) and just to lighten the color of the skin (20.6%). Figure 3 shows that these agents were applied to the whole body in 13.4% of regular us- ers whereas almost two-thirds of them (67.7%) used the products on their faces, 49.1% used them on their necks, and 25.2% used them on their hands. Among current users (n = 230), 8.7% had used bleaching creams continuously for more than 1 year whereas 26.1% of them has used them continuously between 7 and 12 mo. Overall the duration of continuing use ranged between 1 and 72 mo (8.1 ± 10.2) (Table III). Figure 4 illustrates the outcome of discontinuing using TPAs. Less than half of the re- spondents (44.3%) reported that the color of their skin returned to normal once they discontinued the use of bleaching creams whereas 27% of them reported that their skin became even darker than before use. Skin dryness and rash were reported by 20% and 9.6% of users, respectively. WOMEN’S KNOWLEDGE REGARDING USING TPAs Regarding the health knowledge–related to risks attributed to TPAs, only 30.2% of the participants could recognize that mercury is the most harmful chemical to human health, which could be one of the components of bleaching creams whereas cortisone was chosen by more than half of them (53.2%) as shown in Figure 5. Figure 6 demonstrates that 40.4% of the participants believed that misusing bleaching creams could harm their skin. Figure 7 shows that only 15.7% of the women agreed that using TPAs could harm their general health. Figure 3. Ski n areas for application of skin bleaching agents among the participants (n = 389).