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Hyperpigmentation Disorders Linked to OTC Lightening Agent Use


A new study investigates the demographics, trends, and preferences of patients with hyperpigmentation disorders who use over-the-counter (OTC) lightening products in the United States.

In the cross-sectional study, researchers identified 406 adults with cutaneous hyperpigmentation who visited a US-based dermatology clinic between February 2015 and January 2016. Participants were asked to complete a 2-part survey. First, they were asked to answer questions on demographics (ie, age, skin type, marital status, sex, and education), use of OTC or prescription lightening agents, ingredients of products (ie, hydroquinone, triple combination cream, kojic acid, azelic acid, and/or topical steroids), perceived benefit of the cream, monthly expenditures, and accessibility of the lightening agents. The second part of the survey was completed by a board-certified dermatologist who document any hyperpigmentation disorders and skin type of participants.


Skin of Color Treatment Considerations
Melasma Management Considerations
What Are These Hypopigmented Patches?
Of the 406 participants, 88.9% were women and 64.5% had Fitzpatrick Skin Types IV to VI. Melasma and post-inflammatory hyperpigmentation were the most commonly diagnosed skin pigmentation disorders (42.9% and 33.9%, respectively).

Overall, 51% of participants reported using OTC lightening products and 44.9% reported using prescription lightening products. Hydroquinone was the most frequently used cream at 59.1%, followed by triple combination cream (which contained fluocinolone, acetonide, and hydroquinone) at 16.3%. In addition, 28.9% of participants thought that the greater expense of a product was correlated with greater efficacy.

The odds of using an OTC lightening agent were greater for individuals with melasma (OR5.36, CI 2.98-9.63) or post-inflammatory hyperpigmentation (OR 2.38, 95% CI 1.25-4.53).


Of the participants, 56.1% who used an OTC product had also tried a prescription agent and 84.1% consulted a physician at some point during their treatment.


“This primarily descriptive study highlights important aspects of those who use lightening products,” the researchers concluded. “This indicates a large group of patients that dermatologists have the opportunity to educate and advise on proper application of lightening products as well as inform on the side effects of inappropriate use of lightening agents.”


Saade DS, Maymone MBC, Secemsky EA, Kennedy KF, Vashi NA. Patterns of over-the-counter lightening agent use among patients with hyperpigmentation disorders: a United States-based cohort study. J Clin Aesthet Dermatol. 2018;11(7):26–30.

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