Attitude Toward Using the Triple Combination Bleaching Formula and Related Outcomes: A Cross-Sectional Study

Abstract

IntroductionKligman's formula is a topical triple combination consisting of hydroquinone, tretinoin, and topical corticosteroid. It has recently become widely popular among the general population for different purposes. Its improper use can lead to unsatisfactory results and unpleasant side effects. AimThis study aimed to assess the attitude, satisfaction, and complications related to topical usage of Kligman's formula among the general population in Saudi Arabia. Materials and methodsA cross-sectional study was conducted among the general population of Saudi Arabia. A self-administered questionnaire was distributed among the targeted population using an online survey. The questionnaire includes socio-demographic characteristics, assessment of attitude, and satisfaction in using Kligman's formula. Data were tabulated and cleaned, and all statistical analyses were performed. ResultsA total of 292 participants met the inclusion criteria (26 males vs. 266 females) with a mean age of 26.9 (SD 7.71) years. Nearly 40% of participants showed a positive attitude in using Kligman's formula, while 46.9% were satisfied with using it. The most common reason for using Kligman's formula was to lighten the skin (55.8%), while skin redness was the most commonly reported adverse effect. Factors associated with increased attitude and satisfaction were using Kligman's formula based on a doctor's prescription and regular follow-up with a dermatologist. ConclusionThe general population showed an improper attitude toward using Kligman's formula. However, a better attitude and satisfaction rate can be seen among those using Kligman's formula with prescription and those who regularly visit a dermatologist.

A Cross-Sectional Study of the Knowledge, Practice, and Attitude Towards Skin-Lightening Products Among the General Population in the Western Region of Saudi Arabia

“…According to our research, 44.4% of participants used the triple blend without a prescription. This result is similar to another survey when only 26% of the participants took it as recommended by the doctor [ 25 ]. There has been much discussion in most publications about the use of topical steroids without a prescription.…”

“…According to our research, 44.4% of participants used the triple blend without a prescription. This result is similar to another survey when only 26% of the participants took it as recommended by the doctor [25].…”

A Split-Face Comparative Study in Efficacy and Safety between the Combination of 4% Niacinamide and 4% Kojic Acid Cream versus 4% Hydroquinone Cream for Epidermal Melasma

“…11 The topical triple combination known as Kligman's formula has gained popularity among the general population for various purposes. 21,22 The original formula included a mild steroid, dexamethasone 0.1%, in combination with 0.1% tretinoin and 5% hydroquinone in a cream base. This formula has been modified over the years to suit 98 different skin types.…”

“…A study conducted in Saudi Arabia involving a total of 292 participants with a mean age of 26.9 years reported that skin redness was the most commonly mentioned side effect of Kligman's formula (61.6%), followed by a burning sensation (50.7%). 21 A study in 20 melasma patients in India using modified Kligman's regimen for 8 weeks showed the most common adverse effects were acneiform eruption, erythema, and burning. 22 Uncontrolled and long-term use of hydroquinone can cause exogenous ochronosis.…”