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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. We seek to review clinical studies evaluating the use of different Rx-grade and OTC ingredients in treating hyperpigmentation. 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. 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. Careful monitoring and adjustment of doses will be needed to maximize skin lightening benefits and minimize side effects.

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