Regarding the overall knowledge about skin whitening products was, 52% had average knowledge, 32% had poor knowledge and 16% had excellent knowledge. The majority of participants in this study had negative attitude towards skin-whitening. And 38% of the participants had practiced skin-whitening in a point of their lives.
Socio-demographic factors, skin-characteristics and societal factors were significantly associated with knowledge, attitude and practice of skin-whitening.
Most of the participants knew that skin-whitening products can cause adverse side-effects (88%). In alignment with study conducted in University of Al-gezira (7) in Sudan, and another one in Nigeria(10). That indicates that people generally know that skin-whitening can cause adverse side-effects.
Regarding the source of knowledge about the health risks (77.2%) reported that media/social media was their source of information. In alignment with what was found in University of Al-Gezira. (7) This highlights the role of social media in educating about skin-whitening.
Although all of the participants attended medical and health allied faculties only (27%) mentioned the faculty’s curriculum as a source of knowledge which points out the poor role of universities in educating about this matter.
(81.8%) of the participants had poor knowledge regarding skin-whitening agents .Which is even a higher percentage than what was found in university students in Nigeria (56.1%). (10) This might be due to the fact that Nigeria is a leading country in manufacturing skin-whitening products, unlike Sudan, therefor knowledge about this matter is higher.
In this study only (32%) reported a favorable attitude, much lower than what was found in University of Al-gezira, 2015 where (87.9%) reported a favorable attitude. (7) This huge difference indicates that the Sudanese population has developed a less favorable attitude towards skin-whitening in the past 5 years or might be attributed to the different study areas.
(38%) of the participants used skin whitening products. Much lower than results found in the Locality of Omdurman (89.5%). (11) This might be due to the study area, Omdurman locality has one of the largest markets in Sudan ,which is rich with shops and boutiques that sell skin-whitening products.
In this study the majority obtained products from pharmacies, (63.6%), respectively. Similar to results found in high school students in Central Sudan (52.6%) obtained from pharmacies. (12)This highlights the important role of pharmacists in regulating the purchase and use of skin whitening products in Sudan.
It is worth noting that participants who didn’t obtain products through doctor’s prescription and pharmacies, were 3.6 and 3.2 times more likely to be ignorant towards the ingredients present in their skin-whitening products . Which shows that products obtained under doctors and pharmacists supervision are more likely to be labeled with ingredients, thus much safer.
Only (18.6%) experienced complications in this study. Which is much lower than what was found in Ibn-Sena University, where (86%) experienced complications (5). This difference might be because the majority in this study practiced skin-whitening for a short duration. Nearly a half used for 1 to 6 months in this study.
It is worth mentioning that those who obtained products from friends/family members are 11 times more likely to experience side-effects than those who didn’t. Those participants may have used products that aren’t suitable for their skin condition/type.
The main reason for using skin-whitening products, was to treat acne scars (77.9%). Substantially higher than what was found in University of Al-Gezira where, only (26.9%),reported acne and acne scars to be reason of usage (7). This is because; the majority of consumers in this study had combination skin followed by oily skin, which are both prone to acne.
(79.3%) of users in this study were satisfied by the efficacy of the products they’ve used. Similar to results found in Jordan and Omdurman locality in Sudan. Where (70.9%),(75%) were satisfied ,respectively. (13), (11) Which indicates that skin whitening products are indeed efficient in delivering the expected results.
Knowledge about skin-whitening products in this study was associated with, academic year, skin color and skin type. Females with light skin were 1.5 times more likely to have poor knowledge than those with lighter skin. Similar to University of Al- Gezira. (7)This indicates that dark skinned females are more interested in skin-whitening and therefor have more knowledge. Females with combination skin 5 times more likely to have excellent knowledge than dry and normal skin-types, which could be explained by that combination skin is more challenging due to it having oily areas and dry areas, so those who possess it are more educated about skin-products, in order to find what suits them.
It is worth noting that those who had knowledge about the side-effects and those who didn’t, had similar favorable attitudes (32.7% Vs. 24.4%) towards skin-whitening(7) Which indicates that the motives behind skin-whitening are rather strong and not moved by the fear from side-effects.
The use of skin-whiteners was associated with knowledge, skin-type, societal pressure and family history. Generally, Participants with excellent knowledge tended to practice skin-whitening the most compared to those with average and poor knowledge.(58.3% Vs. 39.9%, Vs. 25.6%) This indicates that participants who don’t practice skin-whitening are not interested in the matter therefor have poor knowledge. Females with oily and combination skin were more likely to use skin-whiteners than females with normal and dry skin. This can be explained by the fact that combination and oily skin are more prone to acne therefor acne scars. Which is the main reason for usage in this study.
Societal pressure showed a great impact on the matter of skin-whitening. Where Females who felt pressured by society to whiten their skin were 3.6 times more likely to have a positive attitude and are 2.7 times more likely to practice skin whitening compared to those who don’t feel pressured.
The major source of pressure was media/social media. Similar to what was found in High schools of Central Sudan, where the majority admitted the influence of media in promoting skin whitening. (12).
Participants with a family history of skin-whitening are 4.5 times more likely to whiten their skin compared to those who don’t. Which points out that family usage has a strong influence on whether a person whitens their skin or not.
The study has some limitations, it was limited to female university students, which is not representative of all Sudanese women .It also didn’t include males whom nowadays practice skin-whitening as well. Nonetheless this study gives a general picture about the knowledge attitude and practice of female university students, whom lie in the age group most likely to use skin-whiteners.