Knowledge about, attitude toward, and practice of skin lightening products use and its social correlates among university students in five Association of Southeast Asian Nations (ASEAN) countries

Skin lightening properties of zerumbone cream: A placebo-controlled study

OBJECTIVE

Despite the demonstrated anti-melanogenic and UV protective effects of Zerumbone (ZER) in vitro, there is a lack of clinical trials that have been done to assess these properties. The primary objective of this study was to assess the effectiveness of ZER in lightening the skin tone of human participants with a single-blind approach.

METHODS

Twenty-six participants were randomly assigned to two groups to investigate the application location (left or right volar forearm) for the placebo and ZER creams. Both creams were topically administered to the volar forearms twice daily over a duration of 4 weeks. Initial skin irritation was assessed before and 30 min after applying creams. The melanin and erythema levels were quantified with Mexameter MX 18.

RESULTS

Twenty participants were included in the analysis. The cream formulation had excellent physical properties and was well-received by the participants. The initial skin irritation study results indicated that neither of the creams elicited an allergic reaction. The administration of ZER cream resulted in a statistically significant reduction in melanin levels (p < 0.05) after 1 week compared to the initial baseline. Furthermore, after 2 weeks of application, ZER cream demonstrated significant differences in melanin levels compared to placebo (p < 0.05). No adverse effects were observed in the group using ZER cream.

CONCLUSION

ZER demonstrated significant potential as a skin-lightening agent.

Skin-lightening products and Jordanian women: Beliefs and practice. A cross-sectional study

BACKGROUND

The use of skin-lightening products (SLPs) among Jordanian women has immensely increased and healthcare professionals have a vital role in raising public awareness of SLPs. The aim of this study is to identify SLPs practices among Jordanian women and their basic knowledge of the agents and the side effects associated with using these products.

METHODS

A cross-sectional study conducted during October to December of 2022. Jordanian women above 18 years of age were invited to participate via a survey link. Descriptive statistics were used, and logistic regression was applied to screen for variables affecting the knowledge score of the participants.

RESULTS

The mean age of the study participants (n = 384) was 32.04 (SD = 12.678). Results demonstrated that more than half of the participants (n = 193) reported current or past use of SLPs. Additionally, less than one-fifth (18.2%) of the participants (n = 70) reported previously experiencing some side-effects after using SLPs. About 90% of participants thought that these side-effects were caused by the active ingredients in SLPs. Most of the participants were able to identify some of the active ingredients used in SLPs such as Vitamin C (87.8%) and Hydroquinone (62.0%). It was also found that young participants, and those employed, or university students had higher knowledge scores of SLPs' active ingredients, and of their side-effects.

CONCLUSION

This study demonstrated that Jordanian women are adequately informed about skin-lightening products. Moreover, the practices revealed an educated pattern of action when obtaining information regarding SLPs. Fundamentally, healthcare providers should be influential in educating consumers on the proper use. Strict guidelines and policies should target the practices concerned with these products.

Skin-Lightening Product Use Among South Asian Americans: Cross-Sectional Survey Study

BACKGROUND

Despite their potential for adverse health effects, skin-lightening products remain popular among South Asian Americans.

OBJECTIVE

This study investigates attitudes toward skin tone and the prevalence and adverse effects of skin-lightening product use among South Asian Americans.

METHODS

We conducted a cross-sectional study, recruiting and surveying 175 women or nonbinary individuals meeting the following inclusion criteria: (1) lived in the United States, (2) identified as South Asian, and (3) were raised by parents born in South Asian countries.

RESULTS

Of the 175 participants, 55 (31%) respondents used a skin-lightening product before. Parental pressure to use skin-lightening products and decreased time spent in the United States were significantly associated with skin-lightening product use (odds ratio [OR] 8.51, 95% CI 3.33-21.78, P<.001, and OR 0.70, 95% CI 0.52-0.96, P=.03, respectively). Although only 6 of the 55 (11%) users reported being aware of the potential side effects of skin-lightening products, 33 (60%) reported adverse effects, with acne, skin sensitivity, and dry skin being the most common. Users and nonusers equally endorsed statements associating lighter skin with increased attractiveness (P=.31), marriageability (P=.94), social status (P=.98), self-esteem (P=.73), and respect received from others (P=.74).

CONCLUSIONS

The use of skin-lightening products among South Asian Americans is common and linked to social and psychological factors. Parental pressure and cultural beauty standards may play a significant role in perpetuating this practice. This study highlights the need for educational campaigns about the potential health risks associated with skin-lightening and increased efforts to challenge harmful beauty standards.

Women's knowledge, perception, practice, and experience of using of skin-lightening products in the United Arab Emirates (UAE): A cross-sectional survey

Background

Skin lightening products (SLPs) are popular among women for medical and non-medical reasons. Therefore, this study aimed to determine the extent of SLP use among women, identify their sources of information, explore factors associated with SLP use and SLP related knowledge, attitudes, and practices (KAP) among women in the UAE.

Methods

A structured questionnaire in English and Arabic was distributed to women in the UAE. The questionnaire included demographic characteristics, knowledge (10 items), attitudes (10 items), practices (9 items), and four additional questions on SLP use. Adequate KAP scores were defined as a score of ≥70% out of the maximum score for each KAP section. Chi-square tests were used to test associations between demographic characteristics, dichotomized KAP scores, and SLP use.

Results

The study included 370 participants, 50% of the respondents were aged 18-24, and 40% were from the Middle East, 64.8% were unmarried, 91% had university degrees, and 50% had healthcare related profession. Among the respondents 25% use SLPs, the majority use SLPs for non-medical reasons. Employment status is significantly associated with SLP use. The percentage of participants with a knowledge, attitude, and practice score of ≥70% is 66.48%, 76.75%, and 74.72% respectively. Type of profession was significantly associated knowledge and practice. In addition, nationality was also associated with practice.

Conclusion

This study highlighted knowledge, attitude and practice gaps and varied levels of SLP-related KAP among women in the UAE. To promote the rational use of SLPs, educational campaigns and stricter regulations are necessary.

Effect of body image perception and skin-lightening practices on mental health of Filipino emerging adults: a mixed-methods approach protocol

INTRODUCTION

The rampant distribution of idealised images on the internet may lead the general public to improve their body appearance in a way that is sometimes excessive, compulsive or detrimental to other aspects of their lives. There is a decreasing appreciation of body image among emerging adults and an increasing trend on skin-lightening practices linked with psychological distress. This protocol describes the mixed-method approach to assess the relationships among body image perception, skin-lightening practices and mental well-being of Filipino emerging adults and determine the factors that influence them.

METHODS AND ANALYSIS

An explanatory sequential mixed-method approach will be used. A cross-sectional study design will involve an online self-administered questionnaire of 1258 participants, while a case study design will involve in-depth interviews with 25 participants. Data analysis will use generalised linear models and structural equation modelling with a Bayesian network for the quantitative data. Moreover, the qualitative data will use an inductive approach in thematic analysis. A contiguous narrative approach will integrate the quantitative and qualitative data.

ETHICS AND DISSEMINATION

The University of the Philippines Manila Review Ethics Board has approved this protocol (UPMREB 2022-0407-01). The study results will be disseminated through peer-reviewed articles and conference presentations.

A survey evaluating knowledge, perception, and use of skin lightening products among South African students

Background

In sub-Saharan Africa, the use of skin-lightening products (SLPs) for cosmetic purposes has become common practice among women with dark skin tones. Despite the associated risks, the practice is still significantly increasing in Africa. The objective of this study was to determine the knowledge, perceptions and practice toward skin lightening among young adults.

Methods

A cross-sectional survey among health science students at a tertiary institution in the Western Cape of South Africa was conducted.

Results

A total of 401 participants were included in the sample. There was a low prevalence (12%) of skin-lightening practice among students, which could possibly be a result of students being aware of the associated side effects. Participants believed that family and friends are most likely to influence this behavior (48%) and perceived that individuals who practice skin lightening do so because this provides a more fashionable look (76%). Men and women were found to be equally likely to use SLPs, and those residing in urban settings are 10 times more likely to engage in the practice compared with rural dwellers.

Conclusion

This study contributes valuable information on the phenomenon of skin lightening among a diverse group of young adults. The results highlight the influential role social media platforms and family members play in motivating use of SLPs. Furthermore, the equal likelihood of use among both sexes suggests that the practice is growing among males.

Determination of Phenolic Content, Antioxidant Activity, and Tyrosinase Inhibitory Effects of Functional Cosmetic Creams Available on the Thailand Market

Recently, the global trend toward the use of natural extracts and antioxidant agents in the cosmetic cream industry to produce whitening effects has been increasing. This has also been a persistent trend in Thailand. In this study, samples of commercial cosmetic creams on the Thai market were assessed for a functional evaluation of their antioxidant activity, tyrosinase inhibitory effects, and phenolic contents. Samples were extracted using hot water and sonication extraction method to obtain the functional cream extracts. Total phenolic contents in all samples were within the range of 0.46-47.92 mg GAE/30 g cream. Antioxidant activities of the cream extracts were within the range of 3.61-43.98 mg Trolox equivalent/30 g cream, while tyrosinase inhibition activities were within the range of 2.58-97.94% of inhibition. With regard to the relationship between the total phenolic content and the antioxidant activity of the cosmetic creams, Pearson's correlation coefficient revealed a moderately positive relationship with an r value of 0.6108. Furthermore, the relationship between the antioxidant activity and the tyrosinase inhibitory activity of the cosmetic creams was highly positive with an r value of 0.7238. Overall, this study demonstrated that the total phenolic contents in the functional cosmetic creams could play a role in antioxidant activity and anti-tyrosinase activities. The findings indicate how the whitening and antioxidant effects of cosmetic creams could be maintained after the products have been formulated, as this concern can affect the consumer's decision when purchasing cosmetic products.

Topical corticosteroid withdrawal ('steroid addiction'): an update of a systematic review

BACKGROUND

Topical corticosteroid withdrawal is an entity associated with chronic steroid use and misuse that has not been fully described.

OBJECTIVE

To further characterize this entity, elucidate relevant clinical features, and investigate possible treatments we provided an update to a systematic review done in 2015.

METHODS

We searched Ovid Medline, Pubmed, and Cochrane library for terms related to topical corticosteroid withdrawal from April 2014 to September 2020.

RESULTS

This entity usually occurs after prolonged use of moderate- to high-intensity topical steroid usage usually on the face. It is most common in women and many patients present due to improper use such as for cosmetic reasons. Symptoms include erythema, itchiness, and burning; secondary lesions are common scales.

LIMITATIONS

Due to the paucity of available study, we elected to include all articles found which led to limitations being lack of heterogeneity, diversity of outcome measures reported, and a higher risk of bias in some included studies.

CONCLUSION

Topical corticosteroid withdrawal should be suspected in patients presenting with prolonged usage, erythema, and burning or itch. Patient education and follow up is important to address improper usage. Future studies should focus on comparison group studies to investigate treatment and risk factors.

"The unfair drive to be fair": Psychosocial aspects and implications of the use of skin lightening agents

The quest to be fair is not a concept of the new world. For centuries untold, having a lighter skin tone has been considered as a trait of beauty and supremacy. Society implicates fairness as a factor for getting a prospective life partner. Media portrays fair skin tone as a predecessor for success. These subtle influences affect young minds and drive them towards wanting fair skin. Physicians observe that it is one of the most common forms of body dysmorphic disorder. This article aims to highlight the psychosocial factors that mold this mentality and the possible ill effects it can have on a person, both psychologically as well as physically.

Skin-lightening patterns among female students: A cross-sectional study in Saudi Arabia

Background

Skin-lightening products (SLPs) are commonly used worldwide, and their improper use and overuse is becoming a burden on health care workers, including dermatologists.

Objective

This study aimed to determine the characteristics, determinants, preferences, and side effects of the use of SLPs among Saudi female students and their association with mental health.

Methods

A cross-sectional analytic study, using a self-administered prevalidated questionnaire, was conducted among female students in the Aljouf region of Saudi Arabia. We used the consecutive nonprobability sampling technique to recruit participants. The questionnaire contained demographic data, two questions about knowledge of SLPs, eight questions regarding perceptions of fair skin, and three proxy scales for mental health (depression, posttraumatic stress disorder, and Internet addiction).

Results

The mean age of the participants (± standard deviation) was 29 ± 9.6 years. Of the 760 responders, 427 (56.2%) used SLPs; all were women with relatively light skin (types III-V). There was a unanimous positive perception of lighter skin tone among women. The participants used skin-lighteners for cosmetic and medical conditions (67.2% and 17.5%, respectively). The practice was significantly associated with poor mental health status, poor level of knowledge, and lower sociodemographic status (p < .05).

Conclusions

The use of SLPs is highly prevalent among Saudi female students. Users believe that fairer skin is associated with beauty and social advantage. Female students with a lower economic status and poor mental health are more prone to overuse SLPs. A need exists for targeted public health campaigns to raise public awareness about uncontrolled skin lightener usage.

Colourism: a global adolescent health concern

PURPOSE OF REVIEW

Colourism, a form of prejudice and discrimination based solely upon skin colour, stands to jeopardize the physical health, wellbeing and life chances of adolescents of colour, globally.

RECENT FINDINGS

Research shows that adolescents can experience colourism at school and college, in the criminal justice system, at work and in the media they consume. It is therefore unsurprising that adolescents of colour often express a desire for lighter skin tones and/or are dissatisfied with their skin tone. Although research is scarce, some studies include older adolescents in their samples of skin-lightening product users. This is significant as the evidence is clear that the unmonitored use of skin-lightening products can be harmful to physical and psychological health, with evidence linking skin-lightening use to skin damage, kidney failure and depression.

SUMMARY

Although it is evident that colourism is central to the lives of adolescents of colour, more research is needed concerning the use of skin-lightening products among adolescents. Media literacy and critical race theory offer avenues in helping attenuate the harmful impact of colourism for adolescents of colour.

"Saving Face": An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits

This study reports on an empirically underdocumented practice in contemporary aesthetic enhancement culture, the self-injection of unregulated DIY Botox and dermal filler kits purchased online. Data were collected from 4 online discussion forums containing disclosures in relation to use of DIY kits and analyzed using ethnographic content analysis. Motivation to source DIY Botox and dermal fillers online was grounded in desire to avoid financial cost of professional services and a lack of confidence in practitioners. Future intentions to order online raw materials and "formulas" to prepare dermal fillers at home were expressed. Individuals taught themselves to inject through watching YouTube tutorials and downloading Botox injection maps from the Internet. Although individuals demonstrated awareness of the health risks involved with self-injection of unregulated products, this was not a deterrent. Future research is warranted to document the injecting practices and health outcomes of individuals who inject DIY Botox and dermal filler kits to inform targeted harm reduction interventions by health-care practitioners.

Skin-lightening practices among female high school students in Ghana

OBJECTIVE

The practice of skin lightening (SL) persist despite warnings about its harmful health effects. Adolescents are particularly vulnerable and at risk of prolonged use of SL products. We explored SL practices among high school students in Ghana, West Africa.

STUDY DESIGN

Cross-sectional survey.

METHODS

We used a self-administered questionnaire in a survey on SL practices among randomly selected female students in five Senior High Schools in the Brong Ahafo Region of Ghana. We determined prevalence and used bivariate and multivariate analysis to identify factors associated with the practice.

RESULTS

A total of 410 students with a mean age of 17.6 years (±1.6) participated in the study. While 71.5% of students indicated that they had been approached by relatives and friends to use SL creams, 65.6% admitted to actually using it. Most (85.5%) students identified at least five friends who were using SL products at the time of the survey. Between 22.0% and 44.0% of students knew female teachers who practiced SL. Students in first year were twice as likely to practice SL compared with students in third year (odds ratio [OR] = 1.90, 95% confidence interval [CI] 1.15-3.13). Compared with those who had never been approached, students who had been approached by relatives and friends to use SL products were likely to be using it (OR = 2.24, 95% CI 1.43-3.53). Students who had sisters who used SL products were twice as likely to be users themselves (OR = 1.82, 95% CI 1.12-2.95).

CONCLUSION

The practice of SL among female students in this study is high, and about the same as reported among adults in Ghana and other parts of sub-Saharan Africa. This suggests that the practice is well entrenched. A ban on the sale of SL products to adolescents in Ghana should be considered.