A comparison study of the efficacy between 5% artocarpus lakoocha heartwood extract and 5% niacinamide creams in the treatment of axillary hyperpigmentation: A randomized, double-blind, controlled trial, split-side study in female patients

Abstract

Background: Axillary hyperpigmentation is a common cosmetic concern, particularly in women. While Niacinamide is an established depigmenting agent, Artocarpus lakoocha (Mahad) extract has recently gained attention due to its high oxyresveratrol content, a potent tyrosinase inhibitor. However, clinical evidence in axillary hyperpigmenation remains limited. Objective: To compare the efficacy of 5% Artocarpus lakoocha Heartwood Extract cream with 5% Niacinamide cream in the treatment of axillary hyperpigmentation in female patients. Material and methods: A randomized, double-blind, split-side clinical trial was conducted in 25 female participants with 23 completers (age 20-35 years old) with Fitzpatrick’s skin type III to V. One axilla was treated with 5% Artocarpus lakoocha Heartwood Extract cream and the contralateral side with 5% Niacinamide cream twice daily for 12 weeks. Melanin index was measured by Mexameter® MX18 at baseline, week 4, week 8 and week 12. Patient satisfaction scores were recorded by using Global Satisfaction Scores. Statistical analyses included paired t-tests and repeated-measures ANOVA. Result: At baseline, melanin index was comparable (Mahad 302.17 ± 108.66 vs Niacinamide 299.63 ± 101.80 with p = 0.680). Both treatment showed significant reductions over time (Mahad -59.22, -19.60%, Niacinamide -50.79, -16.95% at week 12). Paired comparisons at week 4, 8, and 12 reveals no significant difference between group (p = 0.103-0.306). Repeated-measures ANOVA demonstrated a significant time effect (p < 0.001), however there was a non-significant time and treatment interaction (p = 0.056). No adverse effects were observed and patient satisfaction was fairly good to good and excellent in both group. Conclusion: Both 5% Artocarpus lakoocha Heartwood Extract and 5% Niacinamide creams were effective and well-tolerated for axillary hyperpigmentation. Mahad demonstrated comparable efficacy to Niacinamide, supporting its potential as a safe, natural alternative for the management of pigmentary disorders.