Pigmentation Conundrums – Underarms – Testing New Kids On The Block

Recently a study published in the journal of Clinical, Cosmetic and Investigational Dermatology has shown that topical niacinamide 4% and desonide 0.05% can help in the treatment of axillary hyper pigmentation.

Axillary (armpit) hyper pigmentation is a frequent cause of cosmetic consultations in dark-skinned women from tropical areas, including Latin America, Asia and Middle East. Currently, there is no widely accepted treatment for the disorder, but it is usually treated with bleaching agents because it is considered a variant of inflammatory hyper pigmentation. The purpose of this study was to assess the efficacy of two new products; niacinamide 4% and desonide 0.05% emulsions compared with placebo in the treatment of axillary hyper pigmentation.

Twenty-four women aged 19–27 years with hyperpigmented axillae (phototype III–V) were randomly assigned to receive the study treatments in the axillary region. Improvement was assessed at baseline, then clinically and by colorimetry 9 weeks later. Quantitative evaluation including melanin, inflammatory infiltrates, NKI/Beteb, CD1a, CD68, and collagen type IV content was performed by histochemistry and immunohistochemistry, assisted by computerized morphometric analysis.

Results: Both niacinamide and desonide induced significant colorimetric improvement compared with placebo; however, desonide showed a better depigmenting effect than niacinamide.

A good to excellent response was achieved in 24% of cases for niacinamide, 30% for desonide, and 6% for placebo. Authors observed a marked disruption of the basal membrane in axillary hyperpigmentation and an inflammatory infiltrate that improved after treatment. Decreased pigmentation in the desonide-treated axillae was associated with recovery of disruption at the basal membrane.

Conclusion: Niacinamide and desonide show depigmenting properties in women with axillary hyperpigmentation. These findings may be explained by their antimelanogenic and anti-inflammatory properties, respectively.

Currently we lack good treatments options when it comes to pigmentation in the underarm area, the addition of these two active agents in our treatment armament will be indeed a pleasant addition. Though more studies will be required to get these active ingredients main stream and know more about the desired and undesired effects.