Expert perspectives on the role of kojic acid in the treatment of hyperpigmentation in dermatology practice in Indian settings

Background: Despite several clinical studies regarding the effectiveness of kojic acid, there is a dearth of studies among clinicians. So, this study aims to gather expert opinions regarding the physician's perspective and preference on the role of kojic acid and its combination in treating hyperpigmentation in Indian settings. Methods: This cross-sectional study utilized a multiple-response questionnaire of 24 questions designed to gather feedback, clinical observations and specialists' experiences in managing hyperpigmentation with kojic acid and its combinations in routine practice. The questionnaire was structured to capture expert opinion on the frequency of use, perceived efficacy, adverse effects and preferences for these combinations. Results: The survey involved 375 clinicians, with the majority (45.87%) preferring kojic acid combinations for treating various indications, including melasma, hyperpigmentation and PIH. Approximately 44% of the respondents reported prescribing kojic acid with glycolic acid to 11-20% of their patients. For peri-orbital melanosis, half of the respondents (50.4%) recommended kojic acid as monotherapy for fewer than 10% of patients, while 39% suggested it for 11-20% of patients. Around 77% of clinicians preferred the combination of kojic acid and glycolic acid for melasma treatment and 68.27% occasionally recommended hydroquinone with kojic acid for melasma. The preferred formulation of kojic acid was a gel, chosen by 48.8% of clinicians, while 43% preferred a cream formulation. Conclusions: This study highlights clinicians’ preference for kojic acid combinations, especially with glycolic acid, for treating hyperpigmentation, particularly melasma. Most clinicians prefer gel formulation. These findings emphasize the popularity of kojic acid, especially in combination therapies, for managing hyperpigmentation.