Axillary Hyperpigmentation Treatment: A Systematic Review of the Literature

Post-inflammatory hyperpigmentation is a common dermatologic complaint that affects different parts of the body. Axillary hyperpigmentation (AH) is a common dermatologic complaint, with no standard treatment. We aim to address the efficacy and safety of the studied treatment modalities for AH.

A systematic search was done using "axillary" and "hyperpigmentation"-related keywords/MeSH terms through PubMed/Medline, Scopus, Web of Science, and Embase.

Ten studies on AH were categorized into topical treatments, light/laser-based therapies, and comparative approaches. Topical agents like niacinamide, desonide, sweet orange extract, Perilla frutescens leaf extract, Cyperus rotundus oil, glycolic acid, and novel serums demonstrated varying degrees of pigmentation reduction, with desonide and C. rotundus oil showing significant effectiveness and minimal side effects. Q-switched Nd:YAG laser was effective across three studies. Both Q-switched Nd:YAG laser and intense pulsed light (IPL) modalities showed significant improvement with minimal adverse events; though pain was more reported with the laser. A comparative study found IPL superior to alpha-hydroxy acid in skin lightening and texture improvement. One study on Curcuma aeruginosa was excluded due to its primary focus on hair growth reduction rather than pigmentation.

The most frequently used laser in treating AH was QS Nd-YAG without having any severe adverse effect. Various topical treatments including Niacinamide, desonide, HQ, AHA, and a few herbal extracts were shown to be effective for AH.