Hydroquinone Levels in Unregulated Skin-Lightening Creams and Women's Knowledge, Attitudes, and Practices Toward Skin-Lightening Products in Hail, Saudi Arabia.

BACKGROUND

Skin-lightening products (SLPs) are widely used in Saudi Arabia, driven by cultural ideals that associate lighter skin tones with beauty and social status. Hydroquinone (HQ), a common ingredient in skin-lightening creams (SLCs), inhibits melanin production but carries risks such as skin irritation, hyperpigmentation, and potential carcinogenicity. This study aimed to evaluate the safety of locally available SLCs and investigate consumer knowledge, attitudes, and practices (KAP) regarding SLP use in Hail, Saudi Arabia.

METHODS

Ten locally available SLCs samples were collected from pharmacies and cosmetic shops in Hail. HQ concentrations were analyzed using validated UV-visible spectrophotometry, while pH levels were measured to assess their safety. A cross-sectional KAP survey of 301 residents was also conducted, exploring awareness, usage habits, and reported side effects of SLPs.

RESULTS

Laboratory analysis showed that 80% of the samples contained HQ, with concentrations reaching as high as 7.1%. As HQ is classified as a prescription-only drug at any concentration in Saudi Arabia, the presence of HQ in unregulated products raises significant safety concerns. pH levels ranged from 2.92 to 10.04, with half of the samples outside the optimal skin pH range, posing concerns about irritation risks. Among survey participants, 63% reported using SLPs, primarily in cream form (91%). While 80% recognized potential risks, only half were aware of the ingredients in their products. Reported side effects included redness (18.75%) and pigmentation issues (15.33%), with 16.33% of users requiring medical care.

CONCLUSION

These findings reveal significant safety concerns surrounding locally available SLCs, with HQ concentrations frequently exceeding permissible limits and unsuitable pH levels exacerbating risks. The widespread use of SLPs despite limited consumer awareness underscores the urgent need for stronger regulations and public education to promote safer cosmetic practices in Saudi Arabia.