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The skin-lightening (SL) industry has a global reach and is projected to continue to grow over the coming decade. Although SL treatments may be safely prescribed for the treatment of some dermatologic conditions, many over-the-counter SL products contain ingredients that can cause harm to the skin and other organ systems. Given a lack of transparent information to patients and the historical colorist foundation that contextualizes a component of the cosmetic SL industry, dermatologists need to navigate biomedical and ethical concerns when explaining SL products to patients. This commentary briefly outlines the medical ethical issues surrounding this topic and describes avenues by which dermatologists may provide informed patient care that best supports beneficence, justice, autonomy, and nonmaleficence., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Hydroquinone has been used for years for multiple conditions, including melasma, post-inflammatory hyperpigmentation, dyschromia from photoaging, and solar lentigines. It is known to be a very effective lightening agent, but several concerns have been raised about this widely used agent. The recent U.S. ban on over-the-counter skin lightening products containing hydroquinone has prompted further questioning of the safety of this widely used agent. While there have been prior informative, large-scale reviews on the safety of hydroquinone, new findings have since been reported. Here, we provide an updated review of studies published in the past 15 years on hydroquinone safety., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Despite the demonstrated anti-melanogenic and UV protective effects of Zerumbone (ZER) in vitro, there is a lack of clinical trials that have been done to assess these properties. The primary objective of this study was to assess the effectiveness of ZER in lightening the skin tone of human participants with a single-blind approach., Methods: Twenty-six participants were randomly assigned to two groups to investigate the application location (left or right volar forearm) for the placebo and ZER creams. Both creams were topically administered to the volar forearms twice daily over a duration of 4 weeks. Initial skin irritation was assessed before and 30 min after applying creams. The melanin and erythema levels were quantified with Mexameter MX 18., Results: Twenty participants were included in the analysis. The cream formulation had excellent physical properties and was well-received by the participants. The initial skin irritation study results indicated that neither of the creams elicited an allergic reaction. The administration of ZER cream resulted in a statistically significant reduction in melanin levels (p < 0.05) after 1 week compared to the initial baseline. Furthermore, after 2 weeks of application, ZER cream demonstrated significant differences in melanin levels compared to placebo (p < 0.05). No adverse effects were observed in the group using ZER cream., Conclusion: ZER demonstrated significant potential as a skin-lightening agent., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: The diverse causes of hyperpigmentation and complex nature of melanogenesis make it a challenge to manage. Current approaches either fail to deliver effective pigmentation control or have undesirable safety profiles that preclude their long-term use., Aims: To evaluate the capacity of a cosmetic gel serum comprising tranexamic acid, niacinamide, 4-butylresorcinol, phytic acid, and a mixture of hydroxy acids that was designed to target the biological processes regulating skin melanogenesis to attenuate melanin production in vitro and reduce hyperpigmentation clinically., Methods: Capacity to reduce melanin production in vitro was determined in melanocyte-containing reconstructed human epidermis (RHEm). Clinical efficacy and skin tolerability following twice daily application were assessed in 35 subjects with slight to moderate facial hyperpigmentation by instrumental (VISIA®-CR, Mexameter®) and clinical (mMASI, clinical score, IGA for hyperpigmentation) evaluation on D14, D28, D56, and D84. Maintenance of pigmentation control was followed up 1 month after cessation of treatment on D112., Results: In RHEm in vitro, melanin production was reduced by 50.0% from baseline (D0) on D14 (p < 0.001) and by 67.0% on D21 (p < 0.001). Clinical reductions from baseline in brown spots count (-9.0%; p < 0.05), brown spots area (-16.7%; p < 0.001), and the melanin index (-11.4%; p < 0.001) were observed within 14 days of use. Statistically significant improvements in all clinical parameters were achieved by D28. By the end of treatment on D84, the number and surface area of brown spots were reduced by 28.4% and 40.3% compared to D0, respectively (p < 0.001, both), the melanin index was reduced by 31.1% (p < 0.001), mMASI was reduced by 63.0% (p < 0.001), and skin luminosity was increased by 79.0% (p < 0.001). IGA was reduced from 2.3 on D0 to 1.3 on D84 (p < 0.001). Improvements to all these parameters were maintained until D112, 1 month after termination of treatment. The product also demonstrated very good skin tolerability., Conclusion: A gel serum comprising tranexamic acid, niacinamide, 4-butylresorcinol, and hydroxy acids, designed to target the biological processes regulating skin melanogenesis, demonstrates rapid, robust, and sustained pigmentation control in this cohort., (© 2024 ISDIN SA. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Facial hyperpigmentation can negatively affect an individual's emotional and psychosocial well-being., Aims: Assess safety and tolerability of a combination of microdermabrasion (DG) procedures using a novel brightening pro-infusion serum (EC-DG) with a targeted at-home treatment regimen in subjects with mild to severe facial hyperpigmentation, including melasma, post-inflammatory hyperpigmentation, and dark spots., Patients/methods: This 12-week, open-label study enrolled 18 subjects (Fitzpatrick skin types I-IV) who underwent 6 in-office DG procedures with EC-DG (one procedure administered biweekly), along with daily topical application of a brightening treatment serum and dark spot cream. End points included change from baseline across multiple skin quality attributes and the Melasma Area and Severity Index (MASI), self-assessment questionnaires, and tolerability assessments., Results: The combination treatment was well tolerated and resulted in significant (p ≤ 0.05) improvements from baseline in radiance, tactile roughness, and moisturization/hydration immediately after the first treatment, in MASI score at day 3, and in overall hyperpigmentation at week 4. Most (94.1%) subjects were satisfied with treatment., Conclusions: DG procedures using EC-DG combined with a targeted at-home skincare regimen are effective and tolerable for treating facial hyperpigmentation across a broad range of skin types., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Skin whitening is a practice that is used to obtain lighter skin tone and is most prevalent in Africa and Asia. Substances used for this procedure, such as hydroquinone or mercury have a variety of side effects and are banned in several countries. This study examined the popularity of internet searches for terms related to skin whitening and bleaching creams with the use of GoogleTrends (GT). GT was searched globally for the topic "skin whitening" and two terms "hydroquinone cream" and "mercury cream" throughout a 10-year period (01.09.2013-31.08.2023). The popularity of searches increased during the analyzed period. The topic "skin whitening" was most popular in Sudan, Vietnam, and Sri Lanka. The searches were higher for "hydroquinone cream" than "mercury cream" in almost all countries, besides the Philippines and Indonesia. Our study confirms that skin whitening practices are popular, especially among populations with darker skin tone. Despite potentially toxic side effects, creams with hydroquinone and mercury are increasingly searched worldwide. Education about skin whitening and the usage of bleaching substances should be implemented, especially in the regions of Africa and Asia.

Background: The use of skin-lightening products (SLPs) among Jordanian women has immensely increased and healthcare professionals have a vital role in raising public awareness of SLPs. The aim of this study is to identify SLPs practices among Jordanian women and their basic knowledge of the agents and the side effects associated with using these products., Methods: A cross-sectional study conducted during October to December of 2022. Jordanian women above 18 years of age were invited to participate via a survey link. Descriptive statistics were used, and logistic regression was applied to screen for variables affecting the knowledge score of the participants., Results: The mean age of the study participants (n = 384) was 32.04 (SD = 12.678). Results demonstrated that more than half of the participants (n = 193) reported current or past use of SLPs. Additionally, less than one-fifth (18.2%) of the participants (n = 70) reported previously experiencing some side-effects after using SLPs. About 90% of participants thought that these side-effects were caused by the active ingredients in SLPs. Most of the participants were able to identify some of the active ingredients used in SLPs such as Vitamin C (87.8%) and Hydroquinone (62.0%). It was also found that young participants, and those employed, or university students had higher knowledge scores of SLPs' active ingredients, and of their side-effects., Conclusion: This study demonstrated that Jordanian women are adequately informed about skin-lightening products. Moreover, the practices revealed an educated pattern of action when obtaining information regarding SLPs. Fundamentally, healthcare providers should be influential in educating consumers on the proper use. Strict guidelines and policies should target the practices concerned with these products., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ayyash et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: the use of skin lightening products (SLPs) by women is poorly documented in Africa, with statistics from some countries entirely missing. This study assessed knowledge, perceptions, practices and factors associated with health risk awareness of African Basotho women towards SLPs., Methods: this was a questionnaire-based cross-sectional study based on convenience sampling of females in secondary/high schools, universities, factories and business offices in Maseru City, Lesotho. Analysis of the differences in knowledge (adequate ≥50% score), perceptions, and practices between four participant groups was based on ANOVA, p<0.05. Associations between sociodemographic variables and the use of SLPs were performed using logistic regression model in SPSS version 27., Results: a total of 468 participants out of 496 responders qualified for data analysis based on predefined data cleaning criteria. Knowledge about SLPs was adequate (78.2%, n=468). By proportion, the main sources of the SLPs were supermarkets (67.6%, n=183) and pharmacy stores (41.9%). About 43.7% (n=468) of the participants used SLPs, with the factory workers mostly associated with SLPs use (aOR: 2.91, 95% CI 1.15-7.40; p=0.02). The majority (53.4%, n=131) of users had inadequate knowledge about the link between skin lightening and skin problems. The most common reasons for use of SLPs were rash (pimples, blemishes) (43.9%, n=107), dry skin (41.1%) and skin reddening (33.6%)., Conclusion: there was adequate knowledge and moderate practice of skin lightening among African Basotho women. Public awareness campaigns and strict regulations are required to address the problem of SLPs use., Competing Interests: The authors declare no competing interests., (Copyright: Nthabiseng Florina Motloh et al.)

Background: Melanin is a skin pigment that gives color to the skin, hair, and eyes. The accumulation or over production of melanin can lead to aesthetic problems as well as serious diseases associated with hyperpigmentation. Skin lightening is described as the procedure of using natural or synthetic products to lighten the skin tone or provide an even skin complexion by reducing the amount of melanin in the skin; therefore, skin lightening products help people to treat their skin problems. Ingredients such as hydroquinone, ascorbic acid, and retinoic acid were used as whitening agents to lighten the skin. However, they have many adverse effects on the skin and body health, such as skin irritation., Aim: In this review, firstly, discuss on the directly/indirectly target melanogenesis-related signal pathways. Secondly, summarize potential natural bioactive ingredients with skin lightening properties from plants, marine organisms, microorganisms. Finally, the remaining problems and future challenges are also discussed., Methods: For relevant literature, a literature search was conducted using Google Scholar and Web of Science. Natural bioactive compounds, tyrosinase inhibitors, and other related topics were researched and evaluated., Results: Natural products isolated from plant and animal resources are potential active cosmetic candidates for lightening the skin tone and skin whitening and protection against UV irradiation. Natural bioactive ingredients as cosmetic whitening additives have attracted increasingly attention due to their safety and cost effectiveness, with few side effects., Conclusion: Although natural active substances have been advocated for use in whitening cosmetics in recent years, there are still many challenges due to the fact that traditional inhibitors are used perennial in cosmetics which cannot be easily changed and the research on natural active substances is still in its infancy. In the future, by improving the extraction technique of natural extracts, it is achieved to give a qualitative and quantitative analysis of the active ingredients of the extracts, to determine the effect of the active components of action, and to find the substances that have the best possible whitening effect in natural organisms., (© 2022 Wiley Periodicals LLC.)

Cosmetic skin lightening is a growing dermatologic public health problem that affects communities of color worldwide. Despite well-documented adverse health effects, cosmetic skin lightening continues to be a popular practice among patients of color. Given the US's changing demographics, it is critical for dermatologists to be knowledgeable about the medical impact as well as social and cultural implications of this practice. This review article aims to serve as a primer for the dermatologist on the medical and sociocultural aspects of cosmetic skin lightening, as well as an approach to discuss the issue of cosmetic skin lightening with patients. We conducted a comprehensive PubMed search using the terms 'skin lightening agents,' 'skin bleaching,' and 'depigmenting agents,' and reviewed the literature on cosmetic skin lightening products, active ingredients, and adverse side effects. Herein, we review the prevalence, ingredients, and health implications of cosmetic skin lightening products. We also provide recommendations for counseling patients who practice cosmetic skin lightening in a culturally sensitive manner.

Skin lightening is a popular practice across the world, especially in India, the Philippines and other Asian countries, and some Caribbean nations. It is a dangerous trend, as some of the products used to achieve a lighter skin tone have been shown to often contain unsafe chemicals. In this article, we examine trends in consumer interest in skin lightening using a Google Trends query of 4 search terms: "skin lightening," "skin brightening," "skin whitening," and "skin bleaching," across the United States from 2015 to 2020, and demonstrated that it is most popular in states with diverse populations, including a high percentage of black and Asian Americans., (© 2022 Wiley Periodicals LLC.)

Skin bleaching, also known as skin lightening, is the deliberate lightening of an individual's skin tone without medical supervision. The causes are complex, multifactorial and often intertwined, although the unifying themes centre around a belief that lighter skin denotes an individual of higher status, socioeconomic background or physical beauty, than their darker-skinned counterpart. Skin lightening is achieved using agents that block the production of melanin and often contain drugs such as hydroquinone, superpotent topical steroids or mercury. These drugs can cause serious local and systemic complication. Skin-lightening compounds are illegal in most countries throughout the world; however the industry is worth billions of dollars annually, and the agents can be easily obtained by individuals seeking to lighten their skin. Dermatologists are in a unique position to identify those at risk of using skin-bleaching agents, manage complications and give advice on the physiological variation in pigmentation and how to avoid using skin-lightening agents to treat dermatological conditions. To manage the belief that lighter skin is better, societal level change is required to ensure that people of all skin tones are represented in the media., (© 2021 British Association of Dermatologists.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Objectives: The 'Black Lives Matter' (BLM) movement in 2020 exemplifies efforts to counter prejudices and the colourist narrative. Harmful use of topical skin lightening agents continues worldwide despite interdiction or restricted use under domestic, European and international regulations., Study Design: Commentary., Methods: Narrative review., Results: In this Short Communication, we consider the significance of societal perspectives of skin colour, glocalized whiteness, efforts to attain self-esteem and social mobility through skin lightening practices, and the role of cosmetic products in fuelling this phenomenon., Conclusions: Addressing the inadvertent (or indeed conscious) vehicles of systematic racism and sustaining of skin colour prejudices and stereotypes of fair skin beauty by cosmetic companies is warranted. Targeted health messaging is an imperative., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Many skin lightening preparations containing hydroquinone, kojic acid, arbutin, and deoxyarbutin are toxic to melanocytes., Objective: This research examined a new skin lightening agent from a family of gem difluorocompounds 2-[2-(2,4-difluorophenyl)-2-propen-1-yl]-1,3-propanediol that also function as tyrosinase inhibitors. This ingredient does not exhibit melanocyte toxicity yet is capable of inducing skin lightening. This research compared the gem difluorocompound, TFC-1067, to hydroquinone evaluating both tolerability and efficacy for lightening facial dyschromia., Method: 48 nonpregnant and non-nursing healthy female subjects age 25-70 years skin types I-IV with mild-to-moderate facial dyschromia were randomized to receive either study product or 2% hydroquinone cream. Subject and investigator tolerability and efficacy assessments were made at baseline, week 4, week 8, and week 12. Dermaspectrophotometer readings from normal skin and a pigmented target area were obtained. All subjects underwent facial photography at each visit., Results: TFC-1067 and 2% hydroquinone produced statistically significant skin lightening after 8 weeks of use, but only hydroquinone lightened the normal skin. This pattern continued into week 12 where both products significantly lightened dyschromic skin, but hydroquinone also lightened the normal skin, which is not always desirable., (© 2020 Wiley Periodicals LLC.)

Background: Esthetically unattractive hyperpigmentation can occur post-inflammatory or as a result of genetic or hormonal influences, UV exposure or medication. Important parameters for the quality of topical treatments are evidence-based in vivo and in vitro efficacy as well as scientifically verified wanted and unwanted effects., Objectives: This paper will present cosmetic and pharmaceutical topical ingredients against hyperpigmentation that have been proven in scientific studies., Materials and Methods: A search of PubMed database was performed in October 2020 using the various ingredient names, "melasma" and "hyperpigmentation." Two reviewers independently screened titles, leading to the selection of 30 papers., Results: Hydroquinone, a tyrosinase inhibitor, has been used for over 40 years to treat hyperpigmentation. It is the most commonly studied agent for lightening pigment. Despite the limited evidence-based research on novel treatment approaches, several ingredients did show efficacy as depigmenting agents, including tyrosinase inhibitors, substances that increase cell turnover, and plant derivatives., Conclusions: Hydroquinone is still the gold standard for the treatment of hyperpigmentation, along with the triple therapy of hydrochinon, tretinoin, and steroids in different modifications. In summary, hyperpigmentation is best treated using a combination therapy of different approaches that includes consequent UV protection.

This review is part of a series of annual updates that summarize the evidence base for atopic eczema (AE). The aim is to provide a succinct guide for clinicians on the key findings from 14 systematic reviews on the prevention and topical treatment of AE published or indexed in 2018. Various supplements, including long-chain polyunsaturated fatty acids, vitamin D and the probiotic Lactobacillus rhamnosus GG, given prenatally and postnatally, have not been shown to prevent AE in infants, although mixed strains of probiotics may decrease the risk of AE if given to the mother during pregnancy and to the infant for the first 6 months of life. In the postnatal period, there is no evidence that hydrolysed formula, compared with cow's milk formula (CMF), reduces the risk of AE in partially breastfed infants. However, weak evidence suggests that a specific partially hydrolysed whey formula decreases the risk of AE compared with CMF. No specific skin practices can be recommended to reduce the eczema risk in healthy term babies. There is weak evidence of a low risk of reversible hypothalamic-pituitary-adrenal axis suppression following 2-4 weeks of treatment with low-potency topical steroids, and conflicting evidence as to whether bleach bathing affects skin flora or AE severity. A single study demonstrated that the topical Janus kinase inhibitor tofacitinib at 2% significantly reduces the Eczema Area and Severity Index compared with vehicle. Topical naltrexone cream 1% improves pruritus (measured using a visual analogue scale) by 30% more than placebo. There is weak evidence that topical alternative therapies, including antioxidants, micronutrients and some herbal medicines, may improve AE., (© 2020 The Authors. Clinical and Experimental Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Melasma is a common disorder of hyperpigmentation that disproportionately affects individuals with skin of color. There is a paucity of studies evaluating non-hydroquinone (HQ) topical therapies for the treatment of melasma in darker skin types., Objective: To compare the safety, efficacy, and tolerability of a HQ-free, retinol-free cosmetic topical brightener (CTB) and HQ 4% in the treatment of moderate symmetric facial melasma in patients with Fitzpatrick skin types (FST) III&ndash;VI. Methods & Materials: This was a randomized, double-blinded, split-face clinical trial. Eighteen adult patients with facial melasma were treated with CTB and HQ 4%, each to a different side of the face, twice daily for 12 weeks. Clinical assessments included half-face Melasma Area Severity Index (MASI), Overall Hyperpigmentation scale, and Melasma Severity Rating Scale (MSRS). Patients completed a Melasma Quality of Life (MelasQoL) questionnaire and clinical photographs were taken at each visit., Results: CTB and HQ 4% demonstrated statistically significant improvements in half-face MASI, Overall Hyperpigmentation, MSRS and MelasQol compared to baseline. HQ 4% showed statistically significant improvements in MSRS at week 12 compared to CTB, but was non-superior for all other clinical endpoints., Conclusion: HQ-free, retinol-free CTB and HQ 4% both are effective and well-tolerated in the treatment of moderate facial melasma in FST III&ndash;VI. J Drugs Dermatol. 2020;19(9):822-827. doi:10.36849/JDD.2020.5353.

Melasma is a chronic dermatologic condition with an incompletely understood pathogenesis and well-demonstrated impact on patient quality of life. Melasma is a common cause for seeking dermatologic care, and with no universally efficacious therapy or cure, com-bination treatment is the best approach for many cases. Numerous studies have demonstrated the role of oxidative stress in patients with melasma, prompting investigation into several antioxidants for melasma therapy. In this review, we discuss the well-defined role of oxidative stress in melasma and the therapeutic efficacy of various antioxidants for patients suffering from melasma. We focus our discussion on studies investigating the role of vitamin C, azelaic acid, cysteamine, glutathione, carotenoids, and numerous other antioxidants in disorders of hyperpigmentation. There is promising evidence for the use of these antioxidants, as topical, oral, and intra-venous preparations, both in isolation and in conjunction with other melasma therapies. J Drugs Dermatol. 2020;19(8):788-792. doi:10.36849/JDD.2020.5079.

Background: Melasma is an acquired disorder of facial pigmentation which is a treatment challenge., Aims: The aim of this article is to critically appraise the clinical trial evidence for different treatment modalities for melasma, published in peer-reviewed journals in the past 10 years., Patients/methods: The literature review was conducted using PubMed and MEDLINE. The search was performed in July 2019, and search parameters were limited to all English language articles published in the past 10 years only., Results: Eighty-nine clinical trials were found. Four clinical trials investigated topical hydroquinone, supporting its safety and efficacy as first-line treatment. Twelve studies showed tranexamic acid as very promising. Nineteen studies assessed various novel oral, injectable, and topical treatments and highlight some new potential future treatments. Forty-two studies investigated laser and light treatment in melasma: LFQS laser is still one of the best options, especially in darker skin types. However, the picosecond laser has shown excellent results. Finally, 11 studies looked at peels. Overall, peels have not been shown to be superior to the use of topical therapy alone., Conclusion: Topical therapy with a HQ and retinoid-based product should be first line for a minimum of 3 months with the addition of oral tranexamic acid at 250 mg BD if no contraindication. Second-line treatment with lasers includes the LFQS Nd:YAG, picosecond laser, and the pulsed dye laser in lighter skin types. Third-line therapy would be the addition of chemical peels to the above treatments, with GA or TCA peels having the most evidence for effectiveness., (© 2019 Wiley Periodicals, Inc.)

Background: Melasma is a common acquired pigmentary disorder characterized by symmetric hyperpigmented macules on the face. Triple combination cream (TCC) remains the gold standard treatment but its prolonged use often causes adverse effects. Recently, studies have shown that topical metformin has melanopenic action., Aims: To evaluate the safety and efficacy of topical metformin in the treatment of melasma and to compare its efficacy with TCC (hydroquinone 2% + tretinoin 0.025% + fluocinolone acetonide 0.01%)., Methods: This was a randomized controlled study conducted on 40 patients with melasma aged more than 18 years. Patients in group 1 (n = 20) were treated with 30% metformin lotion, whereas group 2 patients (n = 20) were treated with TCC for 8 weeks. Pigmentation was assessed using Melasma Area and Severity Index (MASI) at baseline and after 8 weeks. Outcome measures included global improvement scale (grades 1-4) and patient satisfaction. Safety was assessed according to adverse events and patch testing., Results: All 40 patients completed the study. Out of 20 patients in group 1, 11 showed grade 1 improvement (1% to <25%) and grade 2 (25%-50%) and grade 3 (>50%-75%) improvements were seen in one patient each. In group 2, grades 1, 2, 3, and 4 improvements were seen in 14, 2, 1, and 1 patients, respectively. However, the difference was not statistically significant. Adverse events were noted in three patients in group 2 and none in group 1., Conclusion: Topical metformin is a novel, safe, and almost as effective modality as TCC to treat melasma., (© 2019 Wiley Periodicals, Inc.)

Introduction: The standardized litchi extract had been revealed on phytochemical actives, in vitro and cellular activities against aging and darkening of skin. However, a formulation containing the extract has never been developed as per clinical evaluated., Materials and Methods: The litchi serum was developed, safety and efficacy were clinically evaluated in human volunteers. The stable and none irritated 0.05 and 0.1% litchi serums were randomized-single blind placebo control clinical applied on the inner forearm of 29 volunteers for a consecutive 112 days and monitored by Mexameter® MX18, Cutometer® MPA 580 and Visioscan® VC 98., Results: Skin lightening efficacy of the 0.1% and 0.05% litchi serum was significantly (P<0.001 and P<0.05) higher than the placebo. Skin elasticity and wrinkle reduction was significantly (P<0.05 and P<0.005) achieved by the 0.1% litchi serum. The efficacy of litchi serums was confirmed by a split-face, randomized, single-blind controlled that the 0.1% litchi serum was significantly (P<0.05) better than the 0.05% one of all examined parameters., Conclusion: Safety and efficacy of litchi extract are clinically confirmed for hyperpigmentation and aging of skin treatments., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Skin aging has many manifestations such as wrinkles, uneven skin tone, and dryness. Both intrinsic and extrinsic factors, especially ultraviolet light-induced oxidative radicals, contribute to the etiology of aging. Human skin requires both water- and lipid-soluble nutrient components, including hydrophilic and lipophilic antioxidants. Vitamins C and E have important protective effects in the aging process and require exogenous supply. Raspberry leaf extracts contain botanical actives that have the potential to hydrating and moisturizing skin. Topical products with these ingredients may therefore combine to provide improved anti-aging effects over single ingredients., Objectives: To evaluate the anti-aging and brightening effects of an encapsulated serum containing vitamin C (20% w/w), vitamin E, and European raspberry (Rubus idaeus) leaf cell culture extract., Methods: Fifty female volunteers aged 30-65 years were allocated one capsule of serum for topical application on one side of the face for 2 months, in addition to self-use of facial skin products. Both test (treated) and contralateral (untreated) sides were dermatologically assessed after 4 and 8 weeks. Skin color (melanin index), elasticity, radiance, moisture, and water evaporation were measured by Mexameter MX18 ® , Cutometer ® , Glossymeter GL200 ® , Corneometer CM825 ® , and Tewameter TM300 ® instruments, respectively (Courage + Khazaka Electronic GmbH). Skin microtopography parameters, smoothness (SEsm), roughness (SEr), scaliness (SEsc), and wrinkles (SEw), were measured by Visioscan ® VC98 USB (Courage + Khazaka Electronic GmbH), and gross lifting effects were measured by VECTRA ® H1 (Canfield Scientific), and adverse reactions and satisfaction were also assessed., Results: Skin color, elasticity, and radiance were significantly improved. The smoothness, scaliness, and wrinkles were also revealed significant improvement. Mild adverse reactions were tingling and tightness., Conclusions: The vitamin C, vitamin E, and raspberry leaf cell culture extract serum has anti-aging and brightening effects of skin., (© 2020 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals, Inc.)

Coloration plays a crucial role in the social communication and survival of organisms. Multidisciplinary studies have been conducted to elucidate the correlation between coloration and melanin biosynthesis (referred as melanogenesis). The multi-copper enzyme tyrosinase catalyzes the first two steps of melanogenesis for coloration in teleosts. Due to the increasing demand of tyrosinase inhibitors for the production of skin whitening cosmetics, hypopigmentation pharmaceuticals, and anti-browning agents, a large number of natural and synthetic inhibitors have been developed over the past few decades. Although a number of previous studies have focused on human use and toxicity, such as the increased cytotoxic effects of ROS-generating compounds, their ecotoxicological impacts on aquatic organisms are still poorly understood. Hence, the focus of the present review is to describe the role of coloration in teleosts as well as potential ecotoxicological effects elicited by exposure to tyrosinase inhibitors. Furthermore, this review introduces our recently registered adverse outcome pathway (AOP) related to tyrosinase inhibition and population decline in teleosts., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Skin depigmentation is increasingly oriented toward plant extracts because of harmfulness of depigmenting active ingredients used in cosmetics and dermatology. Reconstructed human pigmented epidermis (RHPE) is the closest in vitro model to human skin and offers the possibility to test the global depigmenting effect of a plant extract. These co-cultures of keratinocytes and melanocytes are the most advanced and newest models for testing depigmentation, and until now very few studies have been done with these cultures. We investigated the cytotoxicity and the inhibitory effect on tyrosinase and melanogenesis of four extracts from Combretum micranthum (G. Don) leaves, Anacardium occidentale (L.) fruits, Moringa oleifera (Lam.) seeds, and Adansonia digitata (L.) seeds., Methods: The vegetal extracts were obtained by ultrasound-assisted extraction and the vegetal oils by maceration. Anti-tyrosinase properties of two aqueous extracts were evaluated. Then, the cytotoxicity and depigmenting effects of these plant extracts were tested in vitro with RHPE model delivered by SkinEthic ® ., Results: Antityrosinase activities were found to be 84.58% and 31.02% for C. micranthum and A. occidentale, respectively. All extracts, except A. occidentale, showed to be nontoxic. C. micranthum, M. oleifera, A. digitata, and mixture of M. oleifera and A. digitata extracts have shown, for the first time, an in vitro depigmenting activity equivalent or even more important than kojic acid., Conclusions: These natural extracts coming from Senegal botanical biodiversity could be used in cosmetic and dermatology as alternative agents to achieve skin depigmentation. Further study should be focused on the mechanism of action of these plant extracts., (© 2019 The International Society of Dermatology.)

Introduction: Mercury has long been prohibited for use in skin-lightening agents, but such products are still widely available in many parts of the world. Objective: To evaluate the characteristics of subjects with nephrotic syndrome caused by exposures to skin-lightening products containing mercury and the impact of treatments with chelation agents and/or steroids on the time to achieve remission of proteinuria and normal urine mercury concentrations. Methods: We searched Medline and Embase (1971-31 March 2019), Google Scholar (2001-March 2019) and WanFang Data (1999-March 2019), using mercury, mercury poisoning, cosmetics, skin-lightening and nephrotic syndrome as search terms. Affected subjects must have had nephrotic range proteinuria and a renal biopsy performed. The searches revealed 46 citations, but 32 were excluded because of a doubtful history, incomplete data collection, more than one source of mercury exposures, non-nephrotic proteinuria, treatments by herbal medicines and duplicate articles. The 14 remaining reports describing 30 cases formed the basis of this review. Incidence and geographical origins: There was an obvious increase in the number of reports with more complete information from Asia ( n  = 13) and Europe ( n  = 1) during 2002-2006 ( n  = 3) and 2010-2017 ( n  = 11), involving 3 subjects in 2002-2006 and 27 subjects in 2010-2017. Characteristics of subjects: All 30 subjects were Asian females, mostly aged 18-52 years (median 34 years). Nephrotic syndrome occurred 1-60 months (median 5 months) after exposures to mercury. The proteinuria was heavy (urinary protein excretion 3.2-20.7 g/day, median 5.7 g/day). Other features of mercury toxicity were generally absent. Blood mercury concentrations were normal in 6 subjects and 1.1-10.9 times (median 3.5 times) the upper limit of normal in 14 subjects. Urine mercury concentrations were much higher in 24 subjects, at 1.2-94.6 times (median 9.8 times) the upper limit of normal. Renal biopsy typically revealed minimal change disease (67%) or membranous nephropathy (23%). Etiological importance of mercury: Several clinical observations strongly support the etiological importance of mercury, including a positive relationship between body mercury burden (24-h urine mercury excretion) and severity of proteinuria, the parallel (often proportional) reductions in body mercury burden and proteinuria after cessation of exposures and initiation of chelation therapy and the risk of persistent proteinuria in subjects not treated with chelating agents. Natural history and impact of specific treatments: Spontaneous recovery (within 1.5 months) of mercury-induced nephrotic syndrome was rare.Twenty-three subjects were treated with chelating agents ( n  = 7) or chelating agents plus steroids ( n  = 16). There was relatively clear information on the time to remission of proteinuria (urine protein <150 mg/day) in nine subjects following chelation therapy ( n  = 5) or chelation therapy plus steroids ( n  = 4) (median 2 months, range 1-9 months). In comparison, the time to remission was longer in three subjects not treated with chelation therapy (≥12 months). There were fewer reports with relatively clear information on the time to achieve normal urine mercury concentrations (<35 nmol/day, <50 nmol/L or <5.0 nmol/mmol creatinine). In four subjects with treatment by chelating agents ( n  = 1) or chelating agents plus steroids ( n  = 3), this took 9-16 months (mean ∼11 months). The adjunctive role of steroids in mercury-induced nephrotic syndrome was unclear. Conclusions: Repeated exposures to inorganic mercury in skin-lightening cosmetic products typically cause minimal change disease or membranous nephropathy, resulting in nephrotic syndrome. Apart from cessation of product use, chelation therapy is clearly indicated, in view of the etiological importance of mercury and the presence of increased body burden with target organ damage. The optimal dosages and treatment strategies for unithiol (2,3-dimercapto-1-propanesulfonic acid) and succimer (dimercaptosuccinic acid) have yet to be determined.

Skin color is one of the major attributes that defines both individual distinctiveness and differences between groups. There is a preference for lighter skin world-wide, among both light- and dark-skinned individuals, further leading to skin-color bias based upon skin-color hierarchy within certain ethnoracial groups. The psychiatric and psychosocial ramifications of skin color are important in several situations, including (1) disorders of skin discoloration (eg, vitiligo), which can significantly affect the psychosocial development of the patient especially when it has its first onset during adolescence; (2) widespread use of skin-lightening products, which are used despite knowledge about serious toxicity from inorganic mercury and potent corticosteroids that are some of their main constituents; (3) indoor tanning, which is a recognized carcinogen and practiced by over 50% of university-age adults and 20% of adolescents. Educating about photocarcinogenicity does not change tanning behaviors, which is strongly driven by peer pressure; and (4) when a psychiatric disorder, such as body dysmorphic disorder or major depressive disorder, is the primary basis for skin color dissatisfaction. Despite the role of complex sociocultural and psychiatric factors in clinical manifestations involving skin color, a supportive relation with the dermatologist can significantly aid the patient in managing their disease burden., (Copyright © 2019 Elsevier Inc. All rights reserved.)

White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Pigmentation disorders are therapeutically challenging to treat, requiring complicated regimens. Objectives: Alternatives to hydroquinone (HQ) are desired. We evaluated the efficacy and tolerability of a non-HQ multi-action skin tone corrector (ETCS) developed to inhibit melanin production and improve skin quality. Design and Methods: Twice-daily use of ETCS and ETCS + AHA-Ret, a retinoid-based alpha hydroxy acid cream, was evaluated in subjects with mild to severe dyschromia. Digital images were obtained at baseline, 4, 8, and 12 weeks and included assessment of dyschromia, erythema, fine lines/wrinkles, pores, texture, and global improvement. Melanin Index (MI) measurements were obtained at baseline, 4, 8, and 12 weeks. Subject self-assessments were obtained over the course of the study. Adverse Events (AEs) were collected throughout the study. An extension study evaluated use over 16-weeks. Results: Significant mean reductions from baseline occurred in dyschromia for ETCS (n=42) and ETCS + AHA-Ret (n=10) over 12 weeks (P<0.0001, each). Significant mean reductions from baseline in MI were achieved in both groups at every timepoint (ETCS: P<0.0001; ETCS + AHA-Ret: P<0.02, 4 weeks; P<0.0001, 8 and 12 weeks). Substantial improvements were demonstrated in global improvement, fine lines/wrinkles, erythema, pores, and texture at 12 weeks. Reductions from baseline occurred in dyschromia and MI (P<0.0001, each) at 16 weeks. High levels of subject satisfaction were reported with nearly all subjects reporting reduced appearance of uneven skin tone/discoloration and lightened darker patches, and improvement in overall skin tone. Mild, transient AEs were reported with no discontinuations due to an AE. Conclusions: Twice daily use of ETCS led to early, significant reductions in dyschromia and melanin index. Combination use with a retinoid-based, AHA cream in the evening demonstrated enhanced reductions. ETCS effectively reduced hyperpigmentation, improved overall skin appearance, and was highly tolerable. J Drugs Dermatol. 2019;18(7):642-648.

Background: Long-term exposure of mercury may induce glomerulonephritis. Clinical and pathological features of mercury-associated glomerulonephritis are not fully clear. This study retrospectively analyzed 35 cases of mercury-associated glomerulonephritis in a single Chinese center., Methods: Thirty-five patients of mercury-associated glomerulonephritis were enrolled. Clinical data on diagnosis and during follow-up were collected. Plasma anti-phospholipase A2 receptor (PLA2R) antibody, glomerular PLA2R and glomerular IgG subclasses deposition were detected in the cases with membranous nephropathy (MN)., Results: Mercury exposure was caused by skin lighting cream (20 patients), mercury-containing pills (9 patients), hair-dyeing agents (4 patients), and unidentified reasons (2 patients). All patients presented with proteinuria and normal renal function. The median of urinary protein was 4.6 (range 1.6~19.7) g/24 h. Twenty-two patients (62.9%) had nephrotic syndrome. Renal histopathology showed minimal change disease (MCD) in 21 patients (60.0%), MN in 13 (37.1%) and focal segmental glomerular sclerosis (FSGS) in 1 patient (2.9%). The proportion of MCD increased along with urinary mercury concentration (P = 0.024). In 13 cases of MN, all patients were negative for plasma anti-PLA2R antibody and glomerular PLA2R antigen. IgG1 (61.5%) and IgG4 (46.2%) deposits were noted along the glomerular capillary loops. Among the 16 patients received mercury detoxification monotherapy, 14 patients received 4.5 ± 2.8 (range 1~12) rounds of regimen and achieved complete remission in 4.5 (range 0.3~23.0) months, 2 patients stayed no remission., Conclusions: MCD was the most common pathological type of mercury-associated glomerulonephritis, followed by MN. The proportion of MCD increased along with the increase of urinary mercury concentration. Most patients could achieve complete remission after mercury detoxification.

Introduction: This study aims to determine the prevalence and the factors associated with the use of products for voluntary depigmentation among women aged 15-49 years in Comè health zone in Benin., Methods: We conducted a cross-sectional study of 511 women aged 15-49 years selected using a cluster survey in 2016. Data were collected using a questionnaire seeking to explore the demographic, socio-cultural and economic characteristics of women. Depigmentation ingredients have been identified looking at the composition of regularly used body lotions. We performed a multiple logistic regression analysis. The statistical significance level was set at 5%., Results: The prevalence of use for voluntary depigmentation products among women aged 15-49 years in Comè health zone was 79,22% 95%; CI=[75,72-82,78] and 84,23% of women knew at least one of the adverse health effects associated with the use of skin depigmentation products. The products used were hydroquinone based (98.24%) and dermocorticoid based (1.76%). Factors associated with the use of voluntary depigmentation products included marital status (single, widowed, separated or divorced) (OR=3.1; 95% CI=[1.29-7.44]), the search for a husband or a partner (OR=4.92; 95% CI=[1.20-20.09]), the presence of hyperpigmented spots (OR=10.32; 95% CI=[2.87-37,01])., Conclusion: These results show that the use of skin depigmentation products among women is a serious and huge public health problem in Comè health zone. Integrated communication campaign which can produce positive changes should be implemented., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts.

Exogenous ochronosis (EO) is an entity that manifests as black-bluish or grayish-brown cutaneous hyperpigmentation, which is a consequence of the deposition of ochronotic pigment with characteristic banana-like morphology between the collagen fibers of the dermis. Both the clinical presentation and histopathology appearance are superimposable with endogenous ochronosis or alcaptonuria, a hereditary disease in which ochronotic pigment deposition occurs at a multisystemic level. The most frequent cause of EO is the use of facial depigmenting creams containing hydroquinone, a common practice among women with high phototypes. We present a woman who developed EO on the face, upper chest, and back after prolonged use of a depigmenting cream containing hydroquinone.

Little is known about the anti-pigmenting effects of whitening agents on solar lentigos (SLs), which comprise ~ 60% of hyperpigmented facial lesions of Asian subjects. Lotions with or without 6% L-ascorbate-2-phosphate trisodium salt (APS) [test lotion (TL) and placebo lotion (PL), respectively] were applied twice daily for 24 weeks in a double-blind half-face study of 27 Japanese females with SLs on both sides of their faces. Pigmentation scores were evaluated using a photo-scale and the skin colors were assessed using a color difference meter and a mexameter for SLs and the non-lesional surrounding skin (NLS). Although the pigmentation scores were not significantly different between the TL and PL-treated SLs after 24 weeks, the L values of TL-treated SLs and NLS increased significantly with a significantly higher △L value in SLs than in NLS. In contrast, the L values of PL-treated SLs and NLS remained unchanged after the treatment. The number of subjects with > 2.0 △L was 7 of 27 (TL) and 0 of 27 (PL) in SLs and 3 of 27 (TL) and 0 of 27 (PS) in NLS. In contrast, the melanin index in TL-treated SLs and NLS significantly decreased with a significantly higher △melanin index in SLs than in NLS. Similarly, the melanin index of PL-treated SLs and NLS were significantly decreased with a significantly higher △melanin index in SLs than in NLS. These findings strongly indicate that APS has a weak but significant anti-pigmenting effect on SLs and a significant whitening effect even on normally pigmented healthy skin.

Purpose: To estimate and investigate the global lifetime prevalence and correlates of skin bleaching., Methods: A meta-analysis and meta-regression analysis was performed based on a systematic and comprehensive literature search conducted in Google Scholar, ISI Web of Science, ProQuest, PsycNET, PubMed, and other relevant websites and reference lists. A total of 68 studies (67,665 participants) providing original data on the lifetime prevalence of skin bleaching were included. Publication bias was corrected using the trim and fill procedure., Results: The pooled (imputed) lifetime prevalence of skin bleaching was 27.7% (95% CI: 19.6-37.5, I 2  = 99.6, P < 0.01). The highest significant prevalences were associated with: males (28.0%), topical corticosteroid use (51.8%), Africa (27.1%), persons aged ≤30 years (55.9%), individuals with only primary school education (31.6%), urban or semiurban residents (74.9%), patients (21.3%), data from 2010-2017 (26.8%), dermatological evaluation and testing-based assessment (24.9%), random sampling methods (29.2%), and moderate quality studies (32.3%). The proportion of females in study samples was significantly related to skin bleaching prevalence., Conclusion: Despite some limitations, our results indicate that the practice of skin bleaching is a serious global public health issue that should be addressed through appropriate public health interventions., (© 2018 The International Society of Dermatology.)

The rhizoma of Ligusticum sinense , a Chinese medicinal plant, has long been used as a cosmetic for the whitening and hydrating of the skin in ancient China. In order to investigate the antimelanogenic components of the rhizoma of L. sinense , we performed an antimelanogenesis assay-guided purification using semi-preparative HPLC accompanied with spectroscopic analysis to determine the active components. Based on the bioassay-guided method, 24 compounds were isolated and identified from the ethyl acetate layer of methanolic extracts of L. sinense , and among these, 5-[3-(4-hydroxy-3-methoxyphenyl)allyl]ferulic acid ( 1 ) and cis -4-pentylcyclohex-3-ene-1,2-diol ( 2 ) were new compounds. All the pure isolates were subjected to antimelanogenesis assay using murine melanoma B16-F10 cells. Compound 1 and (3 S ,3a R )-neocnidilide ( 8 ) exhibited antimelanogenesis activities with IC 50 values of 78.9 and 31.1 μM, respectively, without obvious cytotoxicity. Further investigation showed that compound 8 demonstrated significant anti-pigmentation activity on zebrafish embryos (10‒20 μM) compared to arbutin (20 μM), and without any cytotoxicity against normal human epidermal keratinocytes. These findings suggest that (3 S ,3 aR )-neocnidilide ( 8 ) is a potent antimelanogenic and non-cytotoxic natural compound and may be developed potentially as a skin-whitening agent for cosmetic uses.

In this article, we performed a review of all new data of clinical relevance for the dermatologists that were published in the medical literature between September, 2017 and September, 2018. Besides advances that will be useful in day-to-day dermatological practice, we intended to give a more general perspective to this review by taking into account certain international health issues that might in final concern each of us in a globalized world. Focus were more particularly done on the following topics: infectious diseases (including sexually transmitted infections), neglected tropical diseases, adverse effects of drugs, bullous diseases, allergology, wound healing, dermatology on black skin, and public health dermatology., (© 2018 Elsevier Masson SAS. Tous droits réservés.)