title: The use of botanically derived agents for hyperpigmentation: a systematic review.
abstract: BACKGROUND
  Hyperpigmentation disorders are common among those seeking care from dermatologists and primary care physicians. The cosmeceutical and natural product industries are rapidly growing and many botanical agents are purported to improve hyperpigmentation disorders.
  
  
  OBJECTIVE
  We sought to review clinical evidence for the use of botanical agents in the treatment of hyperpigmentation.
  
  
  METHODS
  We searched MEDLINE and Embase databases and a total of 26 articles met inclusion criteria. Study methodology was analyzed and the reproducibility of the studies was graded.
  
  
  RESULTS
  Several botanical agents appear promising as treatment options but few studies were methodologically rigorous. Several plant extract and phytochemicals effectively lighten signs of epidermal melasma and hyperpigmentation induced by ultraviolet radiation exposure. Results were mixed for treatment of solar lentigines or dermal hyperpigmentation.
  
  
  CONCLUSIONS
  There were few rigorously designed studies; future research will be critical to further ascertain the discussed results.
  
  
  CONCLUSIONS
  The subtype of hyperpigmentation is important for treatment prognosis, with dermal hyperpigmentation less responsive to treatment. Botanical extracts may play an integrative role in the treatment of hyperpigmentation and further studies that integrate them with standard therapies are needed. Side effects, including worsened hyperpigmentation, need to be discussed when considering these therapies.
authors.affiliation: School of Medicine, University of California-Davis, Sacramento, California.
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Fisk
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California.
authors.forename: Oma
authors.initials: O
authors.lastname: Agbai
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California; Veterans Affairs Northern California Health Care System, Mather, California.
authors.forename: Hadar A
authors.initials: HA
authors.lastname: Lev-Tov
authors.affiliation: Department of Dermatology, University of California-Davis, Sacramento, California. Electronic address: rksivamani@ucdavis.edu.
authors.forename: Raja K
authors.initials: RK
authors.lastname: Sivamani
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008517:Phytotherapy / Q000379:methods*; D010936:Plant Extracts / Q000627:therapeutic use*; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D010936:Plant Extracts
keywords: botanical; hyperpigmentation; lentigo; melasma; natural; phytochemical; plant