Patterns of Over-the-counter Lightening Agent Use among Patients with Hyperpigmentation Disorders: A United States-based Cohort Study.

Background: Over-the-counter (OTC) lightening agents are commonly used to treat hyperpigmentation disorders. Objective: We sought to determine the characteristics, trends, and preferences of patients with hyperpigmentation disorders seeking OTC agents in the United States. Design: The study was a cross-sectional study of consecutive patients with a disorder of hyperpigmentation seen in a United States-based outpatient dermatology clinic. Multivariable logistic regression models were used to identify factors associated with the use of OTC lightening agents. Setting: The study setting was an outpatient US-based dermatology clinic in Boston, Massachusetts. Results: Of the 406 patients studied, the majority were women (88.9%) with Fitzpatrick Skin Types IV to VI (64.5%). The most frequent diagnoses were melasma (42.9%) and post-inflammatory hyperpigmentation (PIH, 33.9%). Of our responders, 51.0 percent reported use of OTC agents and 44.9 percent reported use of prescription lightening products. Hydroquinone was the most commonly used cream (59.1%), followed by triple combination cream (fluocinolone acetonide, hydroquinone, and tretinoin, 16.3%). Of the cohort, 28.9 percent felt that the greater expense of the product correlated with greater efficacy. After multivariable adjustment, factors associated with a greater odds of using an OTC lightening agent included having a diagnosis of melasma (odds ratio [OR] 5.36; 95% CI: 2.98, 9.63; P<0.01) or PIH (OR 2.38; 95% CI: 1.25, 4.53; P≤0.01). Conclusion: The use of OTC lightening agents is widespread among those patients with hyperpigmentation disorders who reside in the United States. Those with melasma and PIH were more likely to use an OTC lightening cream. The majority of patients believed that OTC creams were safe to use without physician supervision. In those who had also tried prescription products, triple combination was deemed most effective compared to other lightening agents.