As a seemingly endless number of nature-based products take their turn trending in the skin care marketplace, the ancient metabolite kojic acid is enjoying a resurgence in popularity for the treatment of melasma.
Kojic acid is produced by several species of fungi and is a by-product of the fermentation process of malting rice for sake.1 The sometimes-controversial skin lightening agent — also used on cut fruits to prevent browning and in seafood to preserve coloring2 — reduces hyperpigmentation by inhibiting the production of tyrosinase in synthesis of melanin. A potent antioxidant, kojic acid also possesses antibacterial and antifungal properties1 and is used by patients at concentrations ranging from 1% to 4%.3
We spoke with Jared Jagdeo, MD, associate professor of dermatology and director of the Center for Photomedicine at SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, to gain insight into his patients’ use of kojic acid in treating melasma. Dr. Jagdeo established the Laser, Aesthetics and Body Institute to bring state-of-the-art laser technology and comprehensive cosmetic services to dermatology patients at SUNY Downstate. To learn more about Dr. Jagdeo’s practice, visit him on Instagram at @drjaredjagdeo
Your paper in the Journal of Drugs in Dermatology refers to recent “tremendous scientific interest” in topical melasma treatments. To what do you attribute this increase in interest?4
Melasma is a very visible skin condition that has significant psychosocial impact on patients. Melasma is a pigmentary skin disorder that involves the face and has few treatments that work well. In these social media-centric times in which appearance is everything and is constantly being shared and “liked” (or not liked!), I attribute the increased interest in melasma to patients searching for treatments that can improve their quality of life and appearance.
Describe your typical patient seeking/using kojic acid treatment for melasma.
My typical patients seeking melasma therapies are women who are interested in achieving their best look and who want to look as great outside as they feel inside. Patients with melasma are usually outgoing people who spend a lot of their time outdoors enjoying life, and they are seeking treatment to allow them to put their best face forward. Patients who seek newer melasma treatments such as kojic acid are usually those who have tried classic melasma treatments with limited improvement.
Is kojic acid a first-line therapy in treating melasma? If not, what is its place in your toolbox?
In my clinical New York City-based practice, I view kojic acid as a key “hero” agent that is best combined with other agents and procedures to help patients achieve their most even-toned skin possible.
What concentration of kojic acid do you recommend and what is the protocol for using it? Is it used to supplement other therapies?
I use topical products specifically formulated to counter facial skin discoloration that feature kojic acid as an active ingredient prior to and after laser treatments designed to improve melasma.
Kojic acid has irritant qualities — how do you reduce or address these?
The formulations I use that feature kojic acid do not produce significant skin irritation. If patients have mild irritation, it is possible to use the treatment less frequently. Only a very small percentage of my patients — less than 5% — experience irritation.
How is patient adherence and compliance with kojic acid treatment?
Patients are most adherent and compliant with their melasma therapy when they are educated on the timeline of what to expect and the process for skin improvement. With kojic acid, patients can treat themselves at home and usually see improvement as in as little as 4 to 6 weeks, with maximum improvement by 1 year.
Does kojic acid have other applications in addition to treating melasma?
Kojic acid may improve other dark spots on the skin, such as those attributed to post-inflammatory hyperpigmentation; kojic acid can also improve the appearance of photodamage and mild wrinkles.
Do many patients indicate that they are using kojic acid as an overall skin- lightening agent? How do you counsel these patients?
I do not endorse or recommend that patients use kojic acid as an overall skin lightening agent.
What is the best way to use kojic acid responsibly?
Kojic acid has an increasing role in the dermatologist’s toolbox — it is helpful for treating melasma. Patients with melasma should be carefully evaluated by a board-certified dermatologist. Dermatologists are the experts on skin and have special training to treat melasma and other skin conditions.
1. Rodrigues AG. Secondary metabolism and antimicrobial metabolites of aspergillus. In: VK Gupta (ed). New and Future Developments in Microbial Biotechnology and Bioengineering. The Netherlands; Elsevier. 2016; pp 81-93. doi.org/10.1016/B978-0-444-63505-1.00006-3. Accessed March 2, 2020.
2. Sauer M, Mattanovich D, Marx H. Microbial production of organic acids for use in food. In: McNeil B, Archer D, Giavasis I, Harvey L (eds). Microbial Production of Food Ingredients, Enzymes and Nutraceuticals. The Netherlands;Elsevier. 2013;pp. 288-320. doi:https://doi.org/10.1533/9780857093547.2.288
3. Sarkar R, Arora P, Garg KV. Cosmeceuticals for hyperpigmentation: What is available? J Cutan Aesthet Surg. 2013;6(1): 4-11.doi:10.4103/0974-2077.110089
4. Austin E, Nguyen JK, Jagdeo J. Topical treatments for melasma: A systematic review of randomized controlled trials. J Drugs Dermatol. 2019 Nov 1;18(11).