Awareness and Use of Cosmeceuticals among Female Students of Tertiary Institutions in Northeastern N

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Open Access Library Journal > Vol.10 No.2, February 2023

Awareness and Use of Cosmeceuticals among Female Students of Tertiary Institutions in Northeastern Nigeria

Mohammed Tahiru Bolori1*, Bukar Umar Bolori2, Amina Baba Kuchichi3, Ibrahim Musa Ngoshe4, Fatima Lawan Bukar1, Mary Olubisi Amodu1, Sana Arshad5, Somia Gutbi Salim Mohamed6, Halim Rahamtalla Mohamed Ahmed6
1Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria.
2Department of Banking and Finance, Ramat Polytechnic, Maiduguri, Nigeria.
3Department of Sociology and Anthropology, University of Maiduguri, Maiduguri, Nigeria.
4Programs/Operations section UNICEF, Suva, Fiji.
5Department of Dermal Sciences, University of Faisalabad, Faisalabad, Pakistan.
6Department of Public and Environmental Health, Bahri University, Khartoum, Sudan.

1. Introduction

The word “cosmeceutical” came into being in 1984 when a dermatologist known as Dr. Albert Kligman introduced it. [1] Another record showed that in 1961 the term cosmeceutical was conceived by Raymond Reed, a pioneer member of the United States Society of Cosmetic Chemists (USSCC). [2] [3] Dr. Albert Kligman described as the father of cosmeceuticals actually popularized the term cosmeceuticals when he described it in 1984. The cosmeceutical products made an appearance in the world market in 1996. The term “cosmeceutical” has been evolving and most people were confused with cosmetics generally. Some felt that the term cosmeceuticals lack proper definition and its difference from individual cosmetics and pharmaceutical agents seems to be incomplete. The definition of cosmeceutical has always been controversial. [1] There are regulatory issues around the products because the term cosmeceutical is not in existence in the United States Food and Drug Administration records. [4] Cosmeceuticals are agents that combine the properties of cosmetics as well as pharmaceutical drugs. They can affect skin function as well as modify the appearance and the feel of the skin to promote both looks and health conditions. Currently, cosmeceuticals have dominated over any other personal care products across the globe. [1] The anti-aging cosmeceutical (a one group of cosmeceuticals) was valued at USD38.6 billion in 2021. Its value will increase to about USD 60.3 billion in 6 years’ time. [5] A study in 2019 showed that awareness about cosmeceuticals was not adequate, even among community pharmacists in Saudi Arabia let alone ordinary people. [6] A study in Seoul, South Korea, 2017, revealed that total customers’ awareness of cosmeceuticals was described as low, therefore, promotion of awareness was considered necessary. [7] Nowadays, toiletries and skin lightening (bleaching) agents are used the world over, especially in Africa and Asia without public awareness about the correct use of topical creams and their adverse effects on the skin. [8]

This study seeks to demonstrate the awareness of the term cosmeceutical as well as the use of these products among students of tertiary institutions in Northeast Nigeria amidst regulatory issues.

1.1. Objectives

­ To evaluate the level of awareness of cosmeceuticals among the students of tertiary institutions.

­ To determine the practice of the respondents regarding the use of cosmeceuticals.

­ To describe the attitude of the respondents towards the beautifying, healing, and preventive properties of the same product (cosmeceuticals).

­ To determine the level of regulations of cosmeceuticals in the region.

1.2. Cosmeceuticals

Cosmeceuticals are made up of agents that elicit both cosmetic and pharmaceutical effects on the skin to provide beauty, healing and preventive effects. [1] [3] They are cosmetic agents with biological ingredients proven to have drug-like effects. This implies cosmeceuticals contain active ingredients that exert effects on the function of the skin cells. These biological effects may be limited to the skin surface or may penetrate the deeper skin tissues. There are cosmeceuticals of herbal origin which are even more preferred by some users to the synthetic of chemical origins because of their less toxic nature and possession of stronger antioxidant activity. [3]

Cosmeceuticals are available “over-the-counter”, OTC (without prescription) and are generally used as part of a regular skincare regime to help improve skin tone and texture, pigmentation and fine lines. Cosmeceuticals are used for the following on the skin; lightening or depigmenting, as sunscreens, moisturizing, anti-wrinkle/aging, scar-reducing, antioxidants, hair strengthening, and address specific disorder-related problems, such as acne, rosacea, melasma, and others.

Some common ingredients in cosmeceuticals include the following: [3] [9]

­ Sunscreens―These contain agents that protect against sun damage, photo-aging and skin cancers.

­ Antioxidants―Protect from the menace of free radicals damaging the skin tissues by mopping them off. Examples of antioxidants are alpha-lipoic acid, Vitamin C, Nicotinamide (vitamin B3), Vitamin E (alpha-tocopherol), N-Acetyl-Glucosamine (NAG), and Ubiquinone.

­ Hydroxy acids―These are divided into alpha hydroxy acids (AHAs), polyhydroxy acids (PHAs) and beta hydroxy acids (BHAs) by their molecular weights.

­ Retinoids (vitamin A)―These can be natural or synthetic forms of vitamin A and can partly reverse skin changes caused by exposure to sun.

­ Skin lightening agents. Examples include hydroquinone (an agent of choice for skin lightening for many years), ascorbic acid (vitamin C), Kojic acid, Azelaic acid, and Licorice extract (glabridin).

­ Botanicals such as soy, curcumin, silymarin, pycnogenol, ginkgo biloba, green tea extract, grape seed extract, aloe vera, witch hazel, allantoin and ferulic acid.

­ Peptides and proteins―These are short chains of amino acid sequences serving as stimulators of repair or inhibition of processes that accelerate skin aging.

­ Growth factors―They help in wound healing and repair of damaged skin due to sun exposure.

­ Moisturizing agent-emollients (oil based), humectants (water based), and occlusive moisturizers.

Awareness and use of cosmeceuticals―There’s a paucity of literature in terms of awareness of cosmeceuticals among the youths. While searching, I stumbled on a paper titled “Cosmeceutical awareness among Community Pharmacists in Jeddah”, Saudi Arabia: The case of “sunscreens and moisturizers”. The finding revealed that about 53% of community pharmacists were aware of the sunscreens, while 62% were aware of moisturizers. [6] A study conducted among female Saudi University Students showed poor knowledge scores for the hazards of cosmeceuticals warranting health education for the students. [10] The students were not aware and did not care about the indications, method of use or possible adverse effects irrespective of their socioeconomic status. Consumers of these brands are at high risk of many diseases, including cancers. Cosmeceuticals are mostly sold as cosmetics but have performance characteristics of pharmaceutical agent. [1] Many buy and use cosmeceuticals in various forms as cosmetics without knowing the difference. So many the respondents confused cosmeceuticals with cosmetics. A study conducted in Sudan 2021 revealed that 52% and 16% of the respondents had average and excellent knowledge about skin whitening products respectively while 32% had poor knowledge. [11]

Use of cosmeceutical―In the study in Saudi Arabia on the prevalence of cosmeceuticals use published in December 2021, it was stated that 81% of participants used cosmeceuticals with all obtaining the products over the counter (OTC). [10] According to a study conducted in Pakistan 33% of respondents were using potent topical steroids, 17% were using other types of whitening creams exclusively, while another 50% were using topical steroids in combined with various skin whitening creams. [8] That same study titled “Personal-Care Cosmetic Practices in Pakistan: Current Perspectives and Management” revealed that looking good and superior to be more acceptable in society has become the main driver for the use of cosmetics (cosmeceuticals) without knowing its implications. [8] The author felt that the users of such products need to be enlightened about the dangerous consequences related to use of such chemicals. A study conducted at Jimma University, Southwest Ethiopia in 2018 revealed that the majority (80.1%) of respondents were using at least a type of cosmetic product. [12] About 86.6% of the respondents were using toothpaste, lotion, lipstick, or eye makeup. About 19.0% of them experienced adverse events mainly on the face and hair.

Attitude towards the use of cosmeceutical―In a study “Knowledge, Attitude and Practice of Skin Whitening Products, among Sudanese Undergraduate Females, 2021”, the majority (68%) of the respondents had a negative attitude toward skin whitening. [11] The respondents believed that skin whitening raises their chances of getting married (21.9%) as well as secure jobs (18.6%) faster. About 27.7% and 22.2% believed that skin whitening raises their social acceptance and attractiveness respectively.

Cosmeceutical regulation―Under United States law cosmeceuticals are not recognized. [13] Despite the growing market value of cosmeceuticals the United States maintained same position concerning cosmeceutical regulation. The anti-aging cosmeceutical (a one group of cosmeceuticals) was valued at $38.6 billion in 2021. It was estimated that the value will be about 60.3 billion in 2026. [5] The cosmetic industry refers to cosmeceuticals as cosmetic products that have medicinal or drug-like effects. A product can be considered a drug, a cosmetic or both. The United States (US) Food, Drug, and Cosmetic (FD & C) Act refers to drugs as those agents or products that cure, treat, mitigate or prevent diseases. Therefore, if a product is presented with claims or the attributes of a drug, it will be regulated as such. [13] The Food and Drug Administration (FDA) of the US has no statutory or regulatory definition for terminologies such as “cosmetic drugs” or “cosmeceuticals” and therefore, no statutory or regulatory definition exists for this terminology. [14] Cosmetic-drug combination products are subject to FDA’s regulations for both cosmetics and drugs depending on the intended use by the manufacturer. The product’s intended use may be established in several ways, such as claims on the label or in advertising or promotional materials, customer perception of the product, and the inclusion of ingredients that cause the product to be considered a drug because of known therapeutic use. For example, if a lipstick (a cosmetic) contains sunscreen (a drug), the mere inclusion of the term “sunscreen” in the product’s labeling requires the product to be regulated as a drug. Its regulatory status as a drug or cosmetic, or both, is determined by objective evidence of the distributor’s intent. [14] In Pakistan efforts are being made towards strengthening institutions like the Pakistan National Accreditation Council, Pakistan Standards and Quality, Control Authority (PSQCA), Drug Regulatory Authority of Pakistan to implement a quality management system for regulation of the manufacture, import, sale, and distribution of all forms cosmetics. The Ministry of Science and Technology has promulgated laws to regulate skin-enhancing creams all over Pakistan through the PSQCA, whereby a special task force will check manufacturing units, markets, and stores to ensure standards and take legal measures. [8] In Nigeria, the situation is similar. No mention was made of cosmeceuticals by any of the regulatory bodies especially the National Agency for Food and Drug Administration and Control (NAFDAC) which has come up with several regulatory provisions such as the prohibition of unfair or misleading advertisement, prohibition of expired cosmetics products, bleaching creams and other harmful products, wrong use of labels among others. [15]

In the European Union (EU), the United States or Japan, cosmeceuticals are not regulated as may be expected. [3] Cosmeceuticals are considered cosmetics in the EU, as drugs in the United States but have not been approved fully by the U.S. Food and Drug Administration (FDA) while in Japan, cosmeceuticals are regarded as quasi-drugs or quasi pharmaceuticals. Products covered under cosmetics include hair care, oral care, skin care, lipsticks, nail polishes, extenders, deodorants, body powder, aerosols and quasi-pharmaceuticals. [16] A recognized legal definition of cosmeceutical unlike in the case of ordinary cosmetics is currently inexistent anywhere across the globe. [3]

2. Methodology

Study design―It was a cross-sectional descriptive study.

Study locale―The study was conducted in Ramat Polytechnic, one of the tertiary institutes of learning located in Maiduguri, the capital city of the state in northeastern Nigeria. It was established in January 1973 by the government of the defunct North-Eastern State as Technical College. Currently, the institute has one Campus with six Schools, and 34 departments offering 52 different programs.

The Polytechnic offers full and part-time courses of instruction and training leading to National Diploma (ND), Higher National Diploma (HND), Nigeria Certificate in Education (NCE Tech and Bus) and other Certificates of distinctions in Scientific, Technological, Management and Engineering courses to cater for the manpower requirements of the State and the nation. The students run through their programs by staying on or off campus. The Polytechnic offers Post Graduate Diploma through the Consultancy Unit in Management, Finance, Agronomy and Farm Management, Health Education and Hygiene and Education since 2003 in affiliation to the University of Maiduguri.

Study population―The study population was all female students of the institution.

Study samples―Participants were drawn from the institution’s female students for homogeneity and to enhance the maximum flow of information.

2.1. Sample Size

Total of seventy participants were invited for Focus Group Discussions (FGD) in batches of seven persons each. Ten discussions were held to keep the chances of errors at an acceptably low level without making the study too large to minimize cost.

2.2. Data Collection

Focus Group Discussions (FGD) were used to gather the necessary information to cater to the objectives as outlined. Participants’ invitations started about a week before the discussions. Each discussion group comprised 7 participants. Ten FGDs were held within the school in one of the teacher’s offices. This ensured a very conducive and quiet environment for the discussions. In each session of the discussions, the moderator ensured that the participants were seated in a circular arrangement to ensure eye contact and proper and equal participation by all in the discussions. Languages chosen for discussions were Hausa and English understood by all students and mimicked normal communication method while in school. A moderator introduced the discussions in each of the sessions. A note taker was ever ready for a job well done. The moderator used a pretested set of questions to guide the discussions. The questions guide was aimed at respondents’ knowledge of cosmeceuticals and to find out the details of the type of cosmetics they were using to determine whether drugs were in the ingredients as cosmeceuticals. Emphasis was laid on dermal creams, lotion, gels and oils. Other questions seek to find out about regulations on cosmeceuticals, the source of their products, unwanted effects, and attitudes towards cosmeceuticals. Finally, pieces of advice the respondents could provide on the use of cosmeceuticals were discussed. The discussants were explained the meaning of cosmeceuticals after documenting their levels of knowledge on cosmeceuticals. Each discussion lasted for about an hour. All questions were addressed adequately. Responses were recorded on plain sheets of paper. At the end of each discussion, the participants were entertained with a token of appreciation instead of drinks which were monetized.

Key informant interview (KII)―The Chief Regulation Officer of the State National Agency for Food and Drug Administration and Control (NAFDAC) was interviewed on the list of questions related to cosmeceuticals. The list of questions seeks to find out about the respondent’s knowledge of cosmeceuticals, regulation policy for cosmeceuticals and implementation. After understanding his level of knowledge on cosmeceuticals, he was explained the meaning of the word cosmeceuticals on which the remaining questions was based on.

A Study of the ingredients of the products respondents were using was done through leaflets and internet search to differentiate cosmeceuticals from cosmetics.

2.3. Data Analysis

The responses recorded were transcribed and data was entered into a worksheet in an excel computer application for easy analysis. Descriptive statistics were used to calculate the frequencies and percentages and tables and graphs were constructed using data obtained through FGD, KII and details of the products used by respondents through an internet search.

3. Results

The majority of the respondents were within the age groups of 15 to 19 (18.6%) and 20 to 24 years (64.3%). The mean age was 22.8 ± 10.1 years. Almost all (97.1%) respondents were single. Most (64.3%) of the respondents were Muslims (belonging to the religion of Islam) from different tribal groups. (Table 1)

The study showed that none of the respondents ever heard or knew about cosmeceuticals. However, all of them knew about cosmetics. All of them were using cosmetics in form of body creams or lotions at the time of the discussions

Table 1. Socio-demographic data.

and all refuted use of cosmeceuticals. However, it was found in this study that Forty-Six (65.7%) of the 70 respondents were found to be using cosmeceuticals through examination of the ingredients of the products they were using which they described as cosmetics. Twenty-Two (31.4%) of the respondents were actually using body cosmetics creams or lotions as they mentioned while 2 (2.9%) were not using any form of product for cosmetic reasons. (Table 2)

Figure 1 shows a range of cosmeceuticals in body creams or lotions used by participants. The majority (18.0%) of respondents use cocoa butter body cream. Six (about 12.5%) persons were using pharmaceutical drugs (Funbact, Epiderm, Nixoderm, Libya and Silva creams in their body creams as cosmetics. Two of the respondents were using two different body creams at the time of the study. One of the respondents was using a combination of cocoa butter and skineal and the other was using cocoa butter and paw paw lotion.

Funbact, Epiderm and skineal contain steroids, antifungal and antibacterial agents as part of their ingredients as can be seen in Table 3 which also shows Libya cream to contain an antifungal agent. Silva cream contains antibiotics to prevent and treat bacterial infections while Nixoderm contains Salicylic Acid 2 g in 100 g, Benzoic acid, Zinc Oxide, and Sulphur.

Table 2. Usage of cosmeceutical among the respondents.

Figure 1. Range of cosmeceutical cream or lotion used by participants (n = 48).

Table 3. Range and ingredients of cosmeceuticals used by respondents.

Source: Labels of products, internet.

The discussants (100.0%) purchased cosmeceuticals over the counter at markets. Four discussants (8.3%) obtain the products from pharmacies. About 58.3% of the respondents felt the products were easy to get and have never experienced any form of regulation at the point of buying. About 29.2% and 4.2% either had difficulty in obtaining the product due to financial and supply issues respectively while the remaining 8.3% had a combination of both financial and supply issues.

Table 4 shows that beautification accounted for the most (53.0%) reasons for cosmeceuticals use by respondents followed by skin lightening accounting for 15.7%. Skin lightening was also mentioned by some of the respondents to account for 10.4% of the unwanted effects of cosmeceuticals. The table shows

Table 4. Reasons, unwanted effects, attitude and advice related to use of cosmeceuticals.

excessive sweating as one of the most frequently mentioned unwanted effects accounting for 22.9%. The attitudes of the respondent as shown in Table 4 include feelings of stigmatization due to the use of body creams and lotions as beautifying agents or for any of the reasons shown in Table 4. The respondents generally felt that the products are good (41.8%) though they felt that the beautifying agents take over the natural beauty a lady has as mentioned by some (10.9%). This means that the user will have to always rely on the product to maintain her beauty. Many pieces of advice were given to users of cosmeceuticals. The advice includes encouragement of all girls to start using cosmeceuticals (46.2%). However, girls were advised not to use skin bleaching agents (23.1%).

In the KII the informant the State Chief Regulation Officer of the National Agency for Food and Drug Administration and Control (NAFDAC) showed an incomplete understanding of the term cosmeceuticals. However, he affirmed that there is a policy regulation for cosmetics and other related products in the country. The regulation is aimed at controlling manufacturing practices to ensure standards and contents testing, labels, supplies, and adverts. He feels that the policy needs to be reviewed because of the advancement in the field of cosmetics. He advised that the review should be done more frequently by the government. He also advised users ensure using genuine unexpired products by carefully selecting what they buy. The Staff of NAFDAC occasionally visit retailing points to ensure quality and check against forgery and expired products. Defaulters are held to account for their shortcomings.

4. Discussions

The majority of the respondents fell into the age group 15 to 19 and 20 to 24 years contributing to 18.6% and 64.3% respectively as in Table 1. These groups were the ones that like enhancing their beauty and appearance more than the other groups as stated in research on cosmetics usage and its relation to sex, age and marital status which mentions that the age range of 19 - 23 like cosmetics more than the other age groups. [21] Single females like cosmetics more than married ones. Almost all (97.1%) were singles belonging to the group that liked cosmetics more but decrease that tendency after marriage. [21] Most (64.3%) of the respondents were Muslims compared to the Christians (35.7%).

The awareness of cosmeceuticals was zero among the respondents. This was worse than the findings of the studies the researcher came across. In Seoul, Korea in 2017 which revealed that total customers’ awareness of cosmeceuticals was described as low. [7] The awareness about cosmeceuticals was described as inadequate even among community pharmacists in Saudi Arabia according to a study conducted in 2020. [6] Among the community pharmacist 53% knew about sunscreens, 62% knew about moisturizers while the rest of them were not aware. Another study among tertiary students in Saudi Arabia showed poor knowledge of hazards about cosmeceuticals. A study in Sudan among students showed 16%, 52% and 32% had excellent, average and poor knowledge about cosmeceuticals respectively. [11]

About 68.6% of the respondents were using cosmeceuticals without being aware. They thought they were using ordinary cosmetics. A prevalence study of the usage of cosmeceuticals among University students in Saudi Arabia showed a usage rate of 81%. [10] That was much higher than the 68.6% usage rate found in this study. Some of the respondents used medicines (Epiderm, Funbact, Nixoderm, Skineal, Silva and Libya cream) as cosmetics to enhance their appearance and skin condition (see in Figure 1). About 16.6% of the cosmetics mentioned by the respondents contained steroid out of which 6.2% (carowhite, carofresh and CT+) contain hydroquinone (Figure 1 and Table 2). It was obvious that the discussants were using products they do not know much about to enhance their skin conditions. The main reason for the use of cosmeceutical products was to enhance their beauty (53.0%) followed by skin lightening (15.7%). Other reasons given for the use of cosmeceuticals include treatment of pimples/acne (3.6%), rashes (10.8%), deodorant (9.6%), skin softening (4.8%) and reduce sweating (1.2%). The unwanted side effects mentioned by the discussants related to the products they were using include excessive sweating (22.9%), sun burn (16.7%) body odor (14.6%) and skin discoloration (6.3%). It was testified that about 30% of the adverse effects are termed as serious or severe, while the remaining 70 percent were considered mild. [22] Some (10.4%) actually viewed skin lightening as an unwanted effect. After discontinuing the beauty product, the gains in the skin quality will be lost leading to the return of poor skin quality (8.3%). That may lead to getting addicted to the product as believed by some in a study conducted in northeastern Nigeria which mentioned that about 50.5% believe that addiction to use of skin whitening agents can occur. [23] About 10.9% of the respondents asserted that the use of beauty products may lead to stigmatization. This is similar to previous findings in the same region which stated that about 24.7% of respondents thought that stigmatization was an issue in the use of skin whitening agents. [23] However, the discussants in this study felt that cosmetics or cosmeceuticals were good (41.8%) and while some (10.9%) thought that the products were very useful and helpful. Many (46.2%) of the discussants advised all girls to start using cosmeceuticals but to avoid the use of skin whitening agents (23.1%) and other pieces of advice as in Table 2.

There was no indication of regulatory policy and implementation in the manufacturing process, content testing, labeling, advertisements and supply of the cosmeceuticals as well as retail in the state where the study was conducted as mentioned by the key informant. The same thing happens in Pakistan where the Ministry of Science and Technology has promulgated laws to regulate skin-enhancing creams through the PSQCA. A special task force checks manufacturing units, markets, and stores to ensure standards and takes legal measures against defaulters was the case in the study locale. In the European Union cosmetics are subjected to expert safety assessment before being cleared for marketing. [22] However, in the U.S., the FDA only investigate product that has evidence of harm or complaint after being introduced to the market. The EU considers cosmeceuticals as cosmetics with the same laws applied for both, in the US, the FDA considers cosmeceuticals as drugs but not fully recognized, while in Japan cosmeceuticals are considered as quasi-drugs. [3] However, A legally accepted definition of cosmeceutical unlike in the case of ordinary cosmetics is currently inexistent the world over. So far, respondents in this study buy a range of products OTC all forms of cosmeceuticals without any form of restriction.

5. Conclusion

Inappropriate use of cosmeceuticals due to poor knowledge in the northeastern region of Nigeria was noted among students and staff of regulatory agencies while regulation of cosmeceuticals was specifically not addressed.

6. Recommendations

Organize an enlightenment program to empower the students in the tertiary institution to enable them to take informed decisions concerning such products as cosmeceuticals. Similar empowerment program should be extended to the students of other levels within the region. All the stakeholders relevant to the regulation of such cosmeceuticals should be educated on these agents. The government of Nigeria formulates policies with the aim of regulating the use of cosmeceuticals.

Conflicts of Interest

The authors declare no conflicts of interest.


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