Skin lightening practices, beliefs, and self-reported adverse effects among female health science students in Borama, Somaliland: A cross-sectional survey

Abstract

BackgroundSkin-lightening (SL) products are common, especially in Africa. Adverse effects from these products represent a public health concern. Use of these products in Somaliland is unknown.ObjectiveThis study aimed to determine the prevalence of use of SL products among female health science students, beliefs about these products and practices, and adverse effects experienced.MethodsThis was a cross-sectional survey of a convenience sample of female health science students at Amoud University in Borama, Somaliland.ResultsOf the 400 students who were invited to participate, 265 completed the survey (response rate: 66%). Mean participant age was 21.1 years (standard deviation: 2.0 years). The majority of students were single (91.2%) with a Fitzpatrick skin type of 3 or darker (94.2%). Past or present use of SL products was reported by 25.6% of participants, and 52.2% admitted to current use. Compared with non-users, more SL product users agreed that lighter skin color gives a woman more confidence, helps a woman have better job opportunities, and increases chances of getting married. They also agreed that advertisements on television for SL products influence a women’s preference for a lighter skin tone (p < .05). More than 60% of participants were unsure what active ingredients were in their SL products. Only 9% denied any undesirable adverse effects, and the remainder reported an array of local and systemic adverse effects. The vast majority realize that SL products may cause undesirable local (92%) and systemic (89%) adverse effects.LimitationsGeneralizability is limited because a nonrandomized convenience sample from one university was studied. Response bias also may have skewed results.ConclusionUse of SL products among female health science students in Somaliland is common, and causes cutaneous and systemic adverse reactions. Use appears influenced by beliefs about the benefits of lighter skin color. Education is needed on the proper use of these products, how to avoid harmful products, and how to prevent complications.

Skin-lightening practices among shoppers in select markets in Kumasi, Ghana: A cross-sectional survey

“…9,10 In studies of female students in Ghana and Somaliland, more skin-lightening product users agreed that a lighter complexion gives a woman more confidence and increases the number of job opportunities and her chances of getting married. 9,15 These students were also influenced by relatives and advertisements on television. We had similar findings, and the majority of women in this study reported that they engaged in this practice to increase their attractiveness (60.9%).…”

“…13 , 14 A recent study of female health science students in Somaliland found that 25.6% of subjects reported past or present use of skin-lightening products and 52.2% admitted to current use. 15 In Ghana, 1 study found that mercurial soaps and hydroquinone were more commonly used than steroids and the most common cutaneous complications were exogenous ochronosis and colloid milia. 16 In another study, squamous cell carcinoma developed in a patient after prolonged skin lightening with hydroquinone.…”

The dark side of skin lightening: An international collaboration and review of a public health issue affecting dermatology

“…Up to 75% of women in Nigeria ( Dadzie and Petit, 2009 , Dlova et al, 2015 ), 60% in Senegal ( Blay, 2011 ), 50% in Mali ( Baxter, 2000 ), and 30% in Ghana are estimated to use bleaching creams regularly, with similar rates in other African countries ( Lartey et al, 2017 , Mckinley, 2001 ).Throughout the continent, both men and women are frequently targeted with marketing campaigns showing public figures who bleach their skin ( Owusu-Agyei et al, 2020 ). Consequently, individuals claim that lighter skin makes them attractive and increases their career opportunities ( Dlova et al, 2015 , Yusuf et al, 2019 ).…”

“…1 ; Dlova et al, 2015 , Lartey et al, 2017 ). Similarly, in regions of East Africa, 52% of patients use SL products for pigmentary disorders, 38.7% prefer a lighter skin color, and 9.7% report both reasons ( Yusuf et al, 2019 ).

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“…Despite these restrictions, patients are still able to obtain products from street vendors and cosmetic shops, avoiding bans or regulatory constraints ( Dadzie and Petit, 2009 , Dlova et al, 2015 ). Because patients acquire these creams without the counsel of a physician, they are often unaware of the potential side effects and if aware, stop its use only if they personally experience such effects ( Yusuf et al, 2019 ).…”