HEALTH KNOWLEDGE AND ATTITUDE REGARDING BLEACHING AGENTS IN WEST SAUDI ARABIA 111 and lowest among illiterate women (20%). Current usage of TPAs was the highest among women with higher family income ( 20,000 SR/mo 5,000 USD) and the low- est among those with lower family income ( 2,000 SR/mo 500 USD 50% vs. 29.5%). However, the difference did not reach a statistically signifi cant level (p = 0.073). Other sociodemographic factors (marital status and occupation) were not signifi cantly associ- ated with the current usage of TPAs. DISCUSSION TPAs use is a worldwide phenomenon with variable incidence among world countries that may have potential health hazards necessitating patient awareness, education, and counseling. Strength points in this study include discussing an important public health problem that is rarely discussed in Saudi Arabia in addition to inclusion of a relatively big sample size. In a Sudanese study, more than half of the studied subjects (55.4%) misused TPAs whereas 51.6% of them used cosmetics to lighten their skin for a relatively long duration (1–3 years) (18). In Jordan, the prevalence of using skin lightening products was Figure 7. Health k nowledge that overuse or misuse of topical bleaching creams could harm their body and health. Table IV Health Attitude of the Participants Toward Bleaching Agents (n = 389) Agree Strongly N (%) Agree N (%) Do not know N (%) Disagree N (%) Disagree Strongly N (%) Do you consider the use of bleaching creams sold at herbal stores safe? 5 (1.3) 34 (8.7) 113 (29.0) 87 (22.4) 150 (38.6) Do you encourage others to use bleaching creams sold at herbal shops? 5 (1.3) 32 (8.2) 79 (20.3) 109 (28.0) 164 (42.2) Do you want the color of your skin to be lighter than its normal color? 59 (15.2) 156 (40.1) 70 (18.0) 62 (15.9) 42 (10.8)

JOURNAL OF COSMETIC SCIENCE 112 60.7% to treat hyperpigmentary disorders where more than one-third of the women were not aware of the potential side effects of these products (19). In Malaysia, prevalence of skin lightening products usage was 60.6% (20). Askari et al. (2012) studied the preva- lence and determinants of using bleaching products in Pakistan. The prevalence was 59% (21). Dlova et al. (2015) evaluated the skin lightening practices of women in South Africa. The prevalence of using skin lightening products was 32.7%. The main reported reasons were treatment of skin problems (66.7%) and skin lightening (33.3%) (22). In accordance with other studies (17), the prevalence of current usage of TPAs in the pres- ent study was 43.3% and that of regular usage was 73.3%, which is slightly greater than rates reported in a previous Saudi study by Alghamdi with a rate of current usage of 38.9 (16). In Jordan, a prevalence rate of 60.7% has been reported (19) whereas it was 67.2% in Senegal (23) and 72.4% in Lagos, Nigeria (24). In the present study, 13.4% of the participated women applied TPAs to their whole body (Figure 3). This fi gure is higher than that reported by Alghamdi (7.3%) in a previous Saudi study conducted among women visiting outpatient clinics in the Saudi capital, Riyadh (16). This increase in rate may be attributed to the women’s desire to achieve a lighter face and body color infl uenced by the concept of beauty linked to fair skin Table V Reasons for Regular Use of Skin Bleaching Agents Among the Participants (n = 389) Reasons Frequency Percentage To increase beauty 177 45.5 To increase self-esteem 147 37.8 To improve appearance among friends 17 4.4 To increase chances of fi nding a spouse (for single) (n = 155) 21 13.5 To secure and stabilize marriage (for married) (n = 198) 19 9.6 To imply descend from high class 8 2.1 To increase chances of fi nding a job (for unemployed) (n = 79) 5 6.3 To stabilize your situation at your current job (for employed) (n = 145) 3 2.1 To follow fashion 11 2.8 To renew their look 141 36.2 Figure 8. Desire to use bleaching creams that give fast results even if its components are unknown (n = 389).