Researchers study characteristics of people who use over-the-counter skin lightening products

The desire for unblemished, clear skin permeates all cultures and societies, making the practice of skin lightening to minimize spots and even a skin tone quite common worldwide. Internationally, the use of creams to lighten skin is widespread and widely studied. In the U.S. however, information about use of these creams is sparse.

In what is believed to be the first study of its kind, researchers from Boston University School of Medicine (BUSM) studied the types of people who use these creams, why they use them and how well the creams work. Such information they believe could help doctors advise their patients about which creams are the safest and most effective.

In order to understand characteristics associated with the use of lightening products, researchers surveyed 406 adults with cutaneous hyperpigmentation who had been seen in a U.S.-based dermatology clinic from February 2015 through July 2016. Information was collected about patients' demographics, use of over-the-counter (OTC) or prescription lightening products, their components and perceived benefit. Patients also saw a board-certified dermatologist, for assessment of diagnosis, skin type and disease severity.

Of the more than 400 participates in the study, over 70 percent were born outside the U.S. The most common conditions leading to lightening cream use were melasma (brown to gray-brown patches) and post-inflammatory hyperpigmentation (PIH). Less than half reported subjective improvement in their skin tone and results were even worse for those using OTC creams: only 26.5 percent were satisfied with their results. Among those that did report improvement, the most effective agent was prescription-strength triple-combination cream.

The majority (57.5 percent) of these creams were purchased from U.S. pharmacies, but a significant minority were obtained abroad, from community stores or from friends. According to the researchers these unauthorized creams may contain harmful compounds such as mercury, and they emphasize that not all OTC creams are safe to use without supervision.

"This primarily descriptive study highlights important aspects in those who use lightening products," explained corresponding author Neelam Vashi, MD, assistant professor of dermatology at Boston University School of Medicine and director of the Boston University Cosmetic and Laser Center at Boston Medical Center. "More than half of our responders were not satisfied with their OTC creams, reporting that it did not improve their hyperpigmentation."

Approximately half of the sample population, all of which had cosmetically bothersome hyperpigmentation, had tried OTC lightening agents, with the vast majority consulting a clinician during the course of their treatment. "This indicates a very large group of patients that dermatologists have the ability to educate and counsel, advising on proper application and side effects from inappropriate use of lightening agents."