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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 25  |  Issue : 1  |  Page : 26-29

Assessment of the knowledge, attitude, and practice of using hair-smoothing products among women in Saudi Arabia


Department of Dermatology, Faculty of Medicine, University of Hail, Hail, Saudi Arabia

Date of Submission09-Jun-2020
Date of Acceptance25-Jun-2020
Date of Web Publication04-May-2021

Correspondence Address:
Dr. Fawwaz F Alshammrie
Department of Dermatology, Faculty of Medicine, University of Hail, Hail
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_44_20

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  Abstract 


Background: Hair-smoothing products have been developed by the cosmetic industry, targeting the popular desire among women for beautification. The products are also used as a treatment for hair. All hair-smoothing products contain different levels of formaldehyde, which is classified as a carcinogen by the World Health Organization. Purpose: This study aimed to assess the knowledge, attitude, and practice of using hair-smoothing products among women in Saudi Arabia, as well as identifying common side effects of their use. Methods: A cross-sectional study was conducted in 2020 in Saudi Arabia. Self-administered questionnaires were distributed to more than 1600 women, administered in the Arabic language using paper and an online survey. Results: Only 35% of the participants had previously used hair treatments, whereas 24% of the participants identified formaldehyde as a carcinogen. Close to two-thirds (59%) of the participants used hair treatments to facilitate management of their hair. About one-third (35%) of participants read the instructions for hair treatments before their use. The main symptom participants mentioned related to formaldehyde exposure was hair loss (34%). The majority of users (71%) use personal protective equipment during their use of hair-smoothing products. Conclusion: Our study demonstrated low levels of knowledge, a number of misconceptions, and faulty practices. Women must be made aware of the risks of some hair-straightening products that contain large concentrations of formaldehyde exceeding the recommended exposure levels. Therefore, we recommend raising the overall general public knowledge and awareness of hair-straightening products by establishing marketing campaigns and spreading knowledge through social media.

Keywords: Formaldehyde, hair straightening, hair-smoothing treatment, keratin, Saudi Arabia


How to cite this article:
Alshammrie FF, Alshammari TM, Altraifi MA. Assessment of the knowledge, attitude, and practice of using hair-smoothing products among women in Saudi Arabia. J Dermatol Dermatol Surg 2021;25:26-9

How to cite this URL:
Alshammrie FF, Alshammari TM, Altraifi MA. Assessment of the knowledge, attitude, and practice of using hair-smoothing products among women in Saudi Arabia. J Dermatol Dermatol Surg [serial online] 2021 [cited 2021 Dec 2];25:26-9. Available from: https://www.jddsjournal.org/text.asp?2021/25/1/26/315329




  Introduction Top


Hair-smoothing products have been developed by the cosmetic industry, targeting the popular desire for beautification among women. Hair straighteners are also used to ease hair maintenance, besides use reflecting eagerness for social acceptance.[1] Many products meant to make the hair smooth and straight contain a mixture of keratin and formaldehyde.[2] Formaldehyde is a simple, organic molecule that is colorless in nature and has a sharp smell. Its chemical reactivity can cause irritation through direct contact with bodily tissues. Formaldehyde is also absorbed readily by contact through the mouth, nose, eyes, and skin.[3] The use of formaldehyde as a hair straightener emerged in Brazil in 2003. As the practice spreads, high concentrations of formaldehyde were used until public health organizations in Brazil set guidelines that banned the use of concentrations above 0.2% for cosmetics.[4] Besides irritation, loss of sense of smell, dry throat, cough, chest pain, increased upper respiratory tract infections, respiratory tract irritation, wheezing, and shortness of breath can occur. Effects on the nervous system are also possible, usually manifesting as headaches, depression, irritability, and memory problems, especially with long-term exposure. Many allergic dermatitis cases resulting from skin contact have also been reported.[5] Many products on the market are sold as “formaldehyde-free” but may nevertheless contain formaldehyde, which can be listed under other names such as methylene glycol, paraform, and formalin, among many others. Furthermore, some chemicals, such as timonacic acid, release formaldehyde during the hair-smoothing treatment process. All of these factors should be considered before using hair-smoothing products.[6] A study on homemade hair-straightening creams containing high concentrations of formaldehyde showed positive mutagenicity.[7] The International Agency for Research on Cancer (IARC) also concluded that formaldehyde is carcinogenic to humans.[8] The Saudi Food and Drug Authority has also warned against the use of four hair-straightening products on the local market, as they contained large concentrations of formaldehyde in excess of the level set by the Gulf Cooperation Council's standard specifications.[9] This study aimed to assess the knowledge attitude, and practice of using hair-smoothing products among women in Saudi Arabia, as well as identifying the common side effects of their use.


  Methods Top


A cross-sectional, noninterventional study was conducted in the months of February and March 2020, in Saudi Arabia. The study was approved by the Ethics Committee at the University of Hail. Self-administered questionnaires in Arabic were distributed to more than 1600 women on paper and online through Google Forms. The questionnaire gathered socioeconomic data of each respondent, as well as their knowledge, previous experiences, observed side effects, attitude, and practice of keratin hair treatment. Data were analyzed using SPSS version 24 software ,IBM Corporation, Armonk, NY, USA. Descriptive analysis was done using percentages for qualitative variables.


  Results Top


As shown in [Table 1], most participants (68%) are aged between 15 and 24 years, and most are university graduates (72%); 71% had incomes below SAR 5000, and nearly half (53%) reside in the country's middle region.
Table 1: Demographic data

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Only 35% of the participants had previously used hair treatments, whereas 24% knew that formaldehyde is a carcinogen [Figure 1].
Figure 1: Previous usage of hair treatments and thoughts on carcinogenicity

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Nearly two-thirds (59%) of the participants used hair treatments to facilitate hair management. Only 1% used treatments for nourishment and repair, whereas 41% used hair treatments both to facilitate hair management and for nourishment and repair [Figure 2].
Figure 2: Reason for using hair treatment

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Only 35% of participants had read instructions for their hair treatments before use, whereas 18% had tested or examined the hair treatment on their hair before use [Figure 3] and [Figure 4].
Figure 3: Did you read about hair treatments before use?

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Figure 4: Did you test or examine the hair treatment on your hair before use?

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The main symptoms participants mentioned related to formaldehyde exposure were hair loss (34%) and hair dryness and breakage (15%) [Figure 5].
Figure 5: Symptoms related to formaldehyde exposure

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The majority of users (67%) perform keratin hair treatments only once or twice a year; 69% think that commercials are one reason women use keratin hair treatments. Only 44% believe that the nature of their hair makes it necessary to use keratin hair treatments. About half (51%) of the respondents using keratin hair treatment use services offered by salons, whereas only 38% of users perform keratin hair treatments at home. The majority of users (71%) use personal protective equipment, such as a protective mask and gloves, while applying keratin hair treatments, and 82% know that vapors and strong odors are emitted during the keratin hair treatment procedure [Table 2].
Table 2: Attitudes and practices toward keratin hair treatments

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  Discussion Top


The risks to health associated with hair-smoothing keratin treatments remain a source of concern for policymakers and health-care professionals. Individuals who use hair-smoothing products at home or at a salon work environment risk exposure to various chemical compounds. Hair-straightening products containing formaldehyde mixed with keratin are in common use by women in Saudi Arabia.[10] Therefore, this study aimed to determine the percentage of use of formaldehyde mixed with keratin as a hair-straightening product among women in Saudi Arabia and to assess the users' level of awareness related to its hazards.

Only 35% of participants had previously used hair treatments, but just 24% of the participants identified formaldehyde as a carcinogen. A study in humans, along with supporting mechanistic data by the National Toxicology Program, has clearly shown that formaldehyde is a known human carcinogen.[11] Formaldehyde is considered carcinogenic by the World Health Organization, the IARC, the United States Environmental Protection Agency, and the Oregon State Occupational Safety and Health Division, particularly through exposure through the nasal cavity.[12],[13] Coughing, wheezing, eye irritation, contact dermatitis, and other allergic reactions can result from short-term exposure. Returning to this study, about two-thirds (59%) of the participants used hair treatments to facilitate hair management, whereas 41% used hair treatments both to facilitate hair management and for nourishment and repair. Only 35% of participants read the hair treatment's instructions before use, and 18% tested or examined the hair treatment on their hair before use. Participants mentioned hair loss (34%) and hair dryness and breakage (15%) as the main symptoms related to formaldehyde exposure. As Shilpa Amin noted in 2019, some people are more sensitive to formaldehyde exposure to which may also increase the risk of some cancers over time.[14] A medical review noted its links to higher risk of cancers of the nose and blood (leukemia). Formaldehyde may also trigger other health effects, including stinging, burning eyes, nose and throat irritation, runny nose, allergic reactions, coughing, wheezing, chest tightness, itchy skin, skin rash, scalp irritation, scalp burns or blisters, headaches, nausea, mood changes, hair breakage or damage, and hair loss. In 2017, Yara Hameed showed that the most common mild symptoms reported were eye irritation (40.91%), throat irritation and cough (28.48%), burning sensation in the nose (21.52%), headache (17.27%), and nausea (5.76%).[2]

Of respondents to this study, the majority (67%) perform the keratin hair treatment process only once or twice a year; 69% of users think that commercials are one reason women use keratin hair treatments, and 82% know that vapors and strong odors are emitted during the keratin hair treatment procedure. These findings are similar to a 2017 study conducted in Saudi Arabia, which indicated that 61% of women use keratin hair treatments only once or twice a year, 85% thought that commercial advertisements were one of the most important reasons to use keratin hair treatments, and nearly all (91%) agreed that vapors and strong odors evaporate during keratin hair treatment procedures.[2]

Keratin treatment is a chemical process that smooths and shines frizzy hair. The length of time required to complete a keratin treatment depends on the formula used by the stylist, as well as hair texture and volume.[15]


  Conclusion Top


Knowledge, attitudes, and practice of using hair-smoothing products among women in the North of Saudi Arabia have not previously been evaluated. Our study demonstrated low levels of knowledge, a number of misconceptions, and faulty practices. Women must be made aware of the risks of some hair-straightening products that contain large concentrations of formaldehyde exceeding the recommended exposure levels. Therefore, we recommend raising overall general public knowledge and awareness of hair-straightening products by establishing marketing campaigns and spreading knowledge through social media. Limitations of this study are that most participants reside in the central region of Saudi Arabia (68.2%), a region that has high population density compared with other regions. Little work and research have been done in Saudi Arabia or nearby countries related to this topic, which made comparisons difficult.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Miranda-Vilela AL, Botelho AJ, Muehlmann LA. An overview of chemical straightening of human hair: Technical aspects, potential risks to hair fibre and health and legal issues. Int J Cosmet Sci 2014;36:2-11.  Back to cited text no. 1
    
2.
Hameed YN, Elgharabway RM, Ahmed AS. Awareness, prevalence of hair smoothing products that contain formaldehyde and determinants of their harmful effects among women in Saudi Arabia. Int Arch Med 2017;10:1-10.  Back to cited text no. 2
    
3.
Songur A, Ozen OA, Sarsilmaz M. The toxic effects of formaldehyde on the nervous system. Rev Environ Contam Toxicol 2010;203:105-18.  Back to cited text no. 3
    
4.
Gavazzoni Dias M. Hair cosmetics: An overview. Int J Trichol 2015;7:2.  Back to cited text no. 4
    
5.
McCarthy K, McLaughlin D, Montgomery D, Munsell P, Schuster M, Wood M. Keratin-based hair smoothing products and the presence of formaldehyde. Oregon Osha Cohsu Portland 2010;V1,P2-10.  Back to cited text no. 5
    
6.
Occupational Safety and Health Administration. Hair smoothing products that could release formaldehyde. Labor UDo 2011;V1,P1-2.  Back to cited text no. 6
    
7.
Mazzei JL, Figueiredo ÉV, Da Veiga LJ, Aiub CA, Guimarães PI, Felzenszwalb I. Mutagenic risks induced by homemade hair straightening creams with high formaldehyde content. J Appl Toxicol 2010;30:814.  Back to cited text no. 7
    
8.
Cogliano VJ, Grosse Y, Baan RA, Straif K, Secretan MB, Ghissassi FE, Working Group for Meeting report: Summary of IARC monographs on formaldehyde, 2-butoxyethanol, and 1-tert-butoxy-2-propanol. Environ Health Persp 2005;113, 88:1205-8.  Back to cited text no. 8
    
9.
SFDA. SFDA Warns from Using Five Hair Straightening Products as they Contain High Percentage of Formaldehyde; 2016.  Back to cited text no. 9
    
10.
Saudi Food and Drug Authority; 2019. Available from: https://www.sfda.gov.sa/en/drug/news/pages/drug22-11-2016a1.aspx. [Last access esed on 2020 Apr 02].  Back to cited text no. 10
    
11.
Committee to Review the Formaldehyde Assessment in the National Toxicology Program. Twelfth Report on Carcinogens, Board on Environmental Studies and Toxicology. Division on Earth and Life Sciences, National Research Council. Washington, DC: National Academies Press; 2014. Available from: https://www.ncbi.nlm.nih.gov/books/NBK248271/. [Last accessed on 2020 Apr 10].  Back to cited text no. 11
    
12.
Mirabelli MC, Holt SM, Cope JM. Anatomy laboratory instruction and occupational exposure to formaldehyde. Occup Environ Med 2011;68:375-8.  Back to cited text no. 12
    
13.
Zhang L, Freeman LE, Nakamura J, Hecht SS, Vandenberg JJ, Smith MT, et al. Formaldehyde and leukemia: Epidemiology, potential mechanisms, and implications for risk assessment. Environ Molecu Mutag 2010;51:181-91.  Back to cited text no. 13
    
14.
Medline Shilpa Amin, MD, CAQ, FAAFP; 2019. Available from: https://www.healthline.com/health/what-are-the-side-effects-of-a-keratin-treatment. [Last accessed on 2020 Apr 11].  Back to cited text no. 14
    
15.
Ashely. The Everything Guide to Keratin Treatments; 2019. Available from: https://www.thecut.com/2018/05/everything-to-know-about-keratin-treatments.html. [Last accessed on 2020 Apr 12].  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]



 

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