Sir,

Hyperpigmentation constitutes one of the most common skin disorders, having a very broad population distribution all over the globe. This can be accompanied by patches turning dark or discolored on the skin mainly due to exposure to sunlight, hormonal changes, post-inflammatory changes, and even certain medications. How hyperpigmentation affects the self-esteem and quality of life of individuals may be thoroughly crippling and may prompt the patient to seek help and treatments. These may be depigmenting agents such as hydroquinone, retinol, glycolic acid, azelaic acid, tranexamic acid, vitamin C, chemical peels, and lasers [1]. Despite the fact that many treatment options exist, misconceptions about their usage, safety, and effectiveness are rife. Voluntary depigmentation practices are particularly common in sub-Saharan Africa and are often associated with significant systemic complications, metabolic disturbances, and increased risk of skin cancer when performed without medical supervision [2,3]. Furthermore, cultural perceptions of beauty, socioeconomic factors, and the influence of social media contribute to the widespread use of harmful or unregulated skin-lightening products [3,4].

This study, therefore, sought to assess public knowledge pertaining to depigmentation treatments and the most common misconceptions around these treatments, especially in the age of proliferating social media and traditional remedies.

A total of 200 respondents answered the questionnaire consisting of forty items, and these included medical doctors, dermatologists and pharmacists, paramedical personnel, and laypersons. Areas covered in the questionnaire were concerns pertaining to different sources of information on hyperpigmentation, treatment preferences, expected outcomes, and knowledge about different depigmenting agents. Scores were categorized as low (10–14), medium (15–24), and high (≥ 25). Data was analyzed using Jamovi software, version 2.3.28, with comparisons being made across demographic groups.

The variety of literature examined considered prior workings dealing with the occurrences of hyperpigmentation, resolutions, and the role of community education. Works put forward by Maymone et al. and Nouri et al. stress the fact that hyperpigmentation is an issue of great concern for most patients, incorporated with heterogeneous expectations for the outcomes of treatments and the time taken. Other research also studied compliance and effectiveness surrounding depigmentation strategies as they reflect public comprehension and stereotypes.

The participants of this study comprised two hundred individuals, with a sex distribution of 70% females and 30% males. The median age was twenty years. The participants had a diverse professional background, comprising 30% healthcare workers and 70% non-medical persons. Results revealed that 63% of the subjects developed hyperpigmentation, with the most commonly affected locations being the face (38%), inguinal area (17%), and periorbital area (15%), in that order.

Sources of advice to the patients regarding treatment included dermatologists (46%), pharmacists (22%), influencers and peers (18%), and general practitioners (14%). Despite the overwhelming influence of social media and influencers, the dermatologists were considered the most reliable source of treatment advice. As far as the expectations of participants regarding depigmentation therapies were concerned, 63% stated they anticipated improvement to some extent, 33% wanted to be completely healed, and 4% did not expect any restoration. Quite interestingly, 45% expected to obtain results within one month.

Traditional remedies such as Nila (37%), lemon (28%), and milk powder (27%) were popularly used. The patients turned to easily obtained natural remedies, despite the fact that more clinically proven treatments were available. Among the participants interviewed with regard to sun protection, only 23% agreed that sunscreen could prevent hyperpigmentation. This highlighted the importance of public education, since proper sun protection is key in the prevention and management of pigmentation disorders. Among those who used sunscreen, the preferred SPF was 50 (45%), and 32% used ointments with UVA protection.

The study went further to consider the participants’ knowledge of various depigmenting agents, including hydroquinone, retinol, glycolic acid, azelaic acid, tranexamic acid, vitamin C, and chemical peels. Knowledge scores were higher among participants aged 25 to 40 years than those below 25 years (p = 0.013). Women and healthcare professionals had more knowledge of these agents than men and non-professionals (p = 0.01). Those who had a history of hyperpigmentation possessed improved knowledge regarding the treatment (p = 0.01). Participants who received advice on treatment from dermatologists and general practitioners had enhanced knowledge compared to those advised by non-professionals, such as influencers and peers (p = 0.04).

These results indicated important deficiencies in knowledge regarding hyperpigmentation in the broadest public sense. In the selection of options for treatment, dermatology still finds itself in an especially powerful position, the shaping of opinion upon which by social media and influencers is considerable, especially among younger people. Despite widespread exposure to information through these channels, most people have some inaccurate beliefs about the effectiveness of treatments, especially misinformation regarding home remedies and sun protection [5,6].

Studies by Ramos-e-Silva et al. and Dreno et al. demonstrated that a large proportion of patients did not understand the role of sun protection in the management of dermal pigmented disorders, with sunscreen even less often mentioned. This study proved that there remains an urgent need for public education in sun protection concerning daily application and its effectiveness in preventing pigment disorders.

Other difference assessments based on the proportions of patients’ knowledge scores between age groups and vocational diversity reiterated the need for specific educational interventions. Those younger than 25 years scored lower comprehension levels, which were in agreement with Al-Dhalimi et al. [5], who suggested that younger individuals may rely more heavily on social media influencers and less on professional advice. The study further emphasizes that those who themselves have experienced hyperpigmentation are much more likely to seek appropriate information, and personal experience matters in raising awareness. Moreover, the use of unproven alternative treatments suggests that many patients may feel more comfortable with low-cost options. This agrees with research by Zouboulis et al. and Mouangue et al. [7], finding that patients often self-medicate with home remedies due to cultural preferences, misinformation, or limited access to dermatological care. Recent community-based initiatives, such as awareness campaigns and educational caravans, have attempted to curb the popularity of voluntary depigmentation by highlighting its adverse health consequences [8].

The findings of this study provide some insight into the information gaps and misconceptions in the general public regarding the treatment of hyperpigmentation. In the face of increasing influencer presence and social media platforms, there is an apparent need for a more organized public education drive on depigmentation treatments. Greater efforts should be made to promote the importance of sunscreen in preventing hyperpigmentation. Moreover, the advantages of evidence-based treatments over traditional treatments need to be conveyed. Tailored educational programs for the youth may help fill in this knowledge gap, in particular, for individuals who already suffer from hyperpigmentation. Future studies should focus on the investigation into the effects of educative interventions on the effectiveness of education regarding depigmentation treatments and the role of healthcare personnel in further molding public perception and opinion.

REFERENCES

1.Nautiyal A, Wairkar S. Management of hyperpigmentation:Current treatments and emerging therapies. Pigment Cell Melanoma Res. 2021;34:786-801.

2.Akakpo AS, Téclessou JN, Adani-Ife AAO, Kassang P, Mouhari-TouréA, KombatéK, et al. Systemic complications and skin cancers due to voluntary cosmetic depigmentation in sub-Saharan Africa. Our Dermatol Online. 2024;15:409-11.

3.Karabinta Y, Dissa L, KarambéT, Bagayoko H, KaboréM, Sylla O, et al. Challenge of voluntary depigmentation in Mali:Natur’art engages in an awareness caravan against its harmful effects. Our Dermatol Online. 2024;15:80-4.

4.Mouangue KA, Nkoro GA, Sigha OB, Etoa CM, Tounouga DN, Kotto R, et al. Factors determining the occurrence of hyperglycemia in women practicing voluntary depigmentation in four hospitals in Yaoundé, Cameroon. Our Dermatol Online. 2023;14:43-8.

5.Almoshari Y. Medicinal plants used for dermatological disorders among the people of the Kingdom of Saudi Arabia:A narrative review. Saudi J Biol Sci. 2022;29:103303.

6.Fatima S, Braunberger T, Mohammad TF, Kohli I, Hamzavi IH. The role of sunscreen in melasma and postinflammatory hyperpigmentation. J Clin Aesthet Dermatol. 2020;13:28-32.

7.Gaurav V, Bhoi AK, Mehta N. Home remedies in dermatology. Indian J Dermatol. 2023;68:189-95.

8.Prasad V, Mohta A, Mehta RD, Ghiya BC, Soni P, Pareek S. Clinical and dermatoscopic correlation in facial melanosis:A cross-sectional study at a tertiary hospital. Our Dermatol Online. 2023;14:161-9.