Emerging topical therapies to treat pigmentary disorders: an evidence-based approach.

Background: Hyperpigmentation disorders are commonly encountered in dermatology clinics. The use of prescription-grade and over-the-counter topical lightening agents has increased in popularity, leading to a substantial growth of research over the past decade.

Objective: We seek to review clinical studies evaluating the use of different Rx-grade and OTC ingredients in treating hyperpigmentation.

Methods And Materials: A comprehensive search on PubMed was conducted to identify patient-based evidence on the most common ingredients used as topical lightening agents: arbutin, ascorbic acid, cysteamine, hydroquinone, kojic acid, niacinamide, retinoids, and triple-combination therapy. The topicals were classified as either prescription-grade or over-the-counter.

Results: Varying levels of evidence support the use of topicals in treating hyperpigmentation. There were more clinical trials examining Rx-grade products than OTC products. Mild but tolerated side effects are noted in many of these agents.

Conclusion: Careful monitoring and adjustment of doses will be needed to maximize skin lightening benefits and minimize side effects.