HEALTH KNOWLEDGE AND ATTITUDE REGARDING BLEACHING AGENTS IN WEST SAUDI ARABIA 115 between 26 and 40 years and those of higher educational level (university and above) than others. Most women used TPAs against their own recommendation to others. The moti- vation beyond using TPAs is strong. A considerable proportion of the investigated women did not know that overuse or misuse of these products can harm their skin and general body health. Most topical skin bleaching agents were obtained from pharmacies (without a medical prescription), herbal shops, open markets, beauty markets, and cosmetic shops. These products caused skin problems, e.g. skin dryness, itching, and return to original skin color or even darker. Finally, those products were used mostly to increase beauty, self-esteem as well as to renew their look. There is public awareness about possible side effects, although a considerable proportion of the investigated women need more patient education and counseling to guard against malpractice. Cosmetic science and industry needs more research to provide better safe alternatives for many TPAs components, e.g. mercury and hydroquinone. STUDY RECOMMENDATIONS AND FUTURE PERSPECTIVES 1. Usin g TPAs is a repeated daily phenomenon that denotes women care about beauty and smartness. It is a general worldwide common female criterion. 2. Up t o many hundred grams (800 g in our study) of TPAs can be consumed. This necessitates the awareness of the contents and components of the used cosmetics in addition to the follow-up of the prolonged use. 3. Nonp rescribed cosmetics from pharmacies and herbal shops are out of health control with complete lack of dermatologists’ supervision. Contents of such cosmetics are unknown and possible health harm strongly exists. Women’s health education is mandatory. 4. Cosm etics are better to be labeled with a pamphlet that describes clearly the cosmetics content, components, side effects, safety issue for prolonged use, and precautions. 5. Rega rding pricing, many cosmetic preparations are very expensive. Cosmetics industry and trade are quite relevant to women health status. That issue should be brought into control under umbrella of regular health authorities. 6. Cosm etics containing hydroquinone and mercury may carry side effects to the level of toxicity with prolonged overuse and malpractice. Such cosmetics should not be sold outside pharmacies and should never be given without a written doctor’s prescription. 7. Cosm etics containing hydroquinone and mercury should not be used by lactating and pregnant women for fear of teratogenic effects. 8. Publ ic health education, media education, medical magazines, and health announce- ments should be activated. Paid commercial advertisements in the media that attract women to use unknown bleaching agents should be discouraged. 9. Syst emic absorption of TPAs containing mercury and hydroquinone is possible. Regular follow-up of such women is mandatory. Complications of using TPAs, e.g. epidermal atrophy, eczema, dermatitis, and others should be treated by specialized dermatologists. Future usage of TPAs should be modifi ed by shifting to different types that are tolerable. 10. Cos metic science and industry needs more research to provide better safe alternatives for many TPAs components, e.g. mercury and hydroquinone.

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