Cosmeceuticals are a class of cosmetic products that incorporate biologically active ingredients with medicinal or drug-like benefits. They aim to present physiologically relevant benefits without the incorporation of prescription drugs. Although the efficacy and mechanism of action of cosmetics remain incompletely understood, they have gained more attention among the public and the dermatological community (
1,
2). Skin-lightening cream, as a cosmetic product, contains a variety of active ingredients that may exhibit toxic properties. Numerous topical agents are utilized to treat hyperpigmentation, which can interfere with the pigmentation process at multiple stages, such as hydroquinone (HQ), kojic acid (KA), ellagic acid, arbutin, ascorbic acid (AA), linoleic acid, azelaic acid, mercury, acerola fruit extract, methimazole, dioic acid, rucinol, licorice, N-acetylglucosamine, niacinamide, etc. (
3,
4).
The HQ (benzene-1, 4-diol) is a widely utilized depigmenting agent in clinical studies for the management of hyperpigmentation (
5,
6). Topical HQ can result in various adverse effects. Common immediate side effects include irritant or hypopigmentation, allergic contact dermatitis, and post-inflammatory hyperpigmentation. Prolonged use is often associated with exogenous ochronosis, a condition caused by the accumulation and deposition of homogentisic acid in the skin. This condition typically presents with symptoms such as erythema, papulonodules, colloid milia, and symmetric blue-black or gray-brown hyperpigmentation in sun-exposed regions. Chronic users of HQ may also experience trimethylaminuria, commonly known as "fish odor syndrome", characterized by the emission of a foul fish-like smell due to trimethylamine secretion in bodily fluids like sweat, urine, and saliva. Nail hyperpigmentation, although rare, has been documented as a side effect, manifesting as brown pigmentation of the nails, which usually resolves upon discontinuation of HQ usage. Additional side effects may include reduced skin elasticity, impaired wound healing, and peripheral neuropathy. While there have been concerns about the potential carcinogenicity of HQ based on DNA damage observed in animal studies and isolated reports of squamous cell carcinoma in human users, there is currently insufficient evidence to definitively link topical HQ use to cancer or malignant conditions in humans (
7).
The U.S. Food and Drug Administration (FDA) has recommended the removal of over-the-counter (OTC) HQ products due to safety concerns, including potential adverse effects such as cutaneous rashes, ochronosis, and facial edema (
8). Meanwhile, the World Health Organization (WHO) maintains a 2% maximum permissible concentration in skin-lightening products (
9). Arbutin (p-hydroxyphenyl-β-D-glucopyranoside), a bioactive hydrophilic polyphenol and glucoside derivative of HQ, exists in two isomeric forms (alpha-arbutin and beta-arbutin). This compound finds extensive application in cosmetic products as a skin-lightening agent. Some research indicates that the alpha isomer exhibits approximately 10-fold greater efficacy compared to natural arbutin (
10). To demonstrate the skin-lightening effects of arbutin in hyperpigmented skin, deoxyarbutin, as a potent tyrosinase inhibitor, inhibits melanogenesis and tyrosine hydroxylase activity in a dose-dependent manner (
1).
Due to the absence of notable adverse reactions associated with arbutin and its derivatives, they represent a valuable substitute for HQ (
11). It has been reported that various symptoms of contact dermatitis (including erythema, burning, and irritation) are the main adverse effects of topical arbutin application, particularly when combined with other skin-lightening agents (
10). It is advisable to exercise caution when utilizing products containing arbutin, particularly due to the possibility of HQ formation during product application (
12). The European Union's Scientific Committee on Consumer Safety (SCCS) recommended 0.5% and 2% as a safe and effective dose of arbutin for body lotions and facial creams, respectively (
10).
The KA [5-Hydroxy-2-(hydroxymethyl)-4H-pyran-4-one], a fungal-derived skin-lightening agent, exhibits multiple mechanisms of action, including tyrosinase inhibition and suppression of interleukin-6 production in keratinocytes (
13). Although topical products containing KA offer a wide range of advantages, drawbacks such as contact dermatitis and potential photo-induced skin damage should be considered (
14). In fact, contact dermatitis is noted as the main adverse effect associated with KA in topical formulations (
13). The KA and its derivatives also exhibit cytotoxic effects on certain cancer cell lines, including melanoma, hepatocellular carcinoma, ovarian cancer, breast cancer, and colon cancer (
15). Although KA is not approved by the U.S. FDA as an OTC treatment for hyperpigmentation, it is approved for cosmetic use in Canada at concentrations ranging from 0.1% to 30% (w/w). It has been stated by the SCCP that the use of KA over 1% in topical formulations can lead to skin sensitization and harmful effects on the thyroid due to systemic absorption (
16). Additionally, according to the cosmeceutical ingredient review (CIR), this component can be safely employed at a concentration not exceeding 1% because of its cytotoxic properties (
14).
In addition to active ingredients, topical cosmetic formulations typically contain preservatives to prevent microbial degradation (including triclosan, methyl isothiazolinone, and parabens) and oxidative damage [such as AA, butylated hydroxytoluene (BHT), and butylated hydroxyanisole (BHA)] (
17). Although the actual effects of parabens as preservatives [including methyl paraben, ethyl paraben, propyl paraben (PP), and butyl paraben] on human health are in doubt despite safety reviews conducted by the FDA, emerging evidence warns about the potential hazards of these compounds. Parabens are absorbed through the skin, with estimated daily exposure levels reaching around 50 mg. It has been demonstrated that their dermal application containing 0.2% methyl paraben and PP for three months can cause skin irritation, erythema, and edema, with more evident effects observed at higher doses (
18). The buildup of parabens in the human body after repeated dermal application of cosmetic products is significant. From a safety perspective, parabens commonly used in cosmetics generally do not induce allergic reactions, with most sensitization cases occurring when these products are applied to damaged skin. However, despite their low allergenic potential, increasing attention has been directed toward their estrogenic and endocrine-disrupting effects. Although in vivo and in vitro studies suggest that their estrogenic activity is relatively weak, prolonged exposure may contribute to endocrine disruption and potential carcinogenesis (
19). The maximum permissible concentrations of parabens in cosmetic products are regulated at 0.14% for individual compounds and 0.8% for mixtures by European Commission Regulation (EU) No. 1004/2014 (
20).
The AA, a hydrophilic compound, is typically employed at a concentration of about 10% to provide UV protection and inhibit photoaging (
21). Vitamin C is additionally utilized for the treatment of hyperpigmented skin spots and is applied topically, intravenously, and transdermally (
22). The BHA and BHT are used in cosmetic formulations as synthetic hydrophobic antioxidants in a range of 0.0002 - 0.5% (w/w). The amount of 0 - 0.125 mg/kg has been established for the acceptable daily intake (ADI) of BHA by the WHO. While limited toxicological data are available regarding topical application, some research claims that higher doses may induce pulmonary toxicity in mice and rats (
23).