What is Hydroquinone?
Hydroquinone is a topically applied skin bleaching (whitening) ingredient available both by prescription and in several OTC (over the counter) products.
Why would you want to bleach your skin? First, just to be clear, we are using the term "bleaching" to simply refer to the process of "lightening" the skin in areas of unnatural darker pigmentation (known as hyperpigmentation). We are not talking (as I'm sure you know) about literally putting liquid bleach onto the skin. Don't ever do that!
HOW DOES HYDROQUINONE WORK?
Hydroquinone interferes with the normal process by which our skin cells (specifically, melanocytes) manufacture melanin (the substance that gives our skin a darker color). It generally takes 4-6 weeks of daily application of hydroquinone to begin to see results.
In order to enhance the effectiveness of hydroquinone, some products (Tri-Luma for example) add "tretinoin" (an ingredient usually used to treat acne). Other products include sunscreens because UV radiation from the sun is known to worsen hyperpigmentation.
AVAILABLE PRODUCTS WITH HYDROQUINONE IN THE U.S.
What hydroquinone products are available? Below is a list of just several hydroquinone containing products that are currently available.
Epiquin Micro cream
Hydroquinone microspheres 4%
Hydroquinone 4%, Fluocinolone 0.01%, Tretinoin 0.05%
Melasma - Before and After treatment
CAUSES OF SKIN DISCOLORATION:
Skin discoloration is due to an over-production of melanin in our skin.
This over-production melanin is sometimes the result of:
1. Excessive sunlight and/or exposure to UV radiation while taking other medications such as:
- Estrogen Replacement Therapy (ERT)
2. Pregnancy (usually resolves itself after giving birth)
3. Melasma - See photo above (specifically characterised by spots/patches on the face, often during pregnancy, but can happen to men as well)
4. Skin trauma (injury)
5. Other prescription drugs such as antibiotics, drugs for malaria and antiarrhythmics.
Hydroquinone topically applied to the affected area(s) helps to reduce the darkness of the skin by interfering with the production of melanin in that area. This ordinarily takes 4-6 weeks, and may need to be continued.
IS HYDROQUINONE SAFE?
As with most medications, there are some concerns which patients should be aware of prior to using hydroquinone for their skin pigment condition.
It should be pointed out that the FDA was initially concerned about the potential for hydroquinone to cause cancer. Laboratory studies seemed to suggest this was a potential risk. Further studies, however, have not found the topical preparations of hydroquinone to be a cancer risk for humans.
1. Skin Irritation - It is recommended that patients first apply a small amount of the cream to the skin and allow about 24 hours to ensure no severe skin reaction occurs. Minor redness is normal, but excessive redness and inflammation is not. If this occurs, stop the product immediately.
2. Ochronosis - This is a relatively rare and uncommon side effect characterized by a blue/black darkening and sooty appearance to the skin. This is seen more frequently in African Americans, and most often with dosages above 2%. This condition is somewhat difficult to treat, so patients should be aware of the potential risk.
3. Sulfite allergy - Some individuals have allergic reactions to sulfites. If so, check with your pharmacist about whether the product you are being prescribed may have sulfites (Epiquin Micro is an example of a product containing sulfites).
Did You Know?
Oral Contraceptive Pills (OCP's) commonly cause mild skin discoloration. This is due to the hormonal changes introduced by the estrogen and progestins in these products. It is recommended that all women taking contraceptives should be especially careful to avoid excessive sun exposure (which can make it worse) and to always wear a good sunblock.
The Pharmacist's Advice
So what is my advice on the use of hydroquinone containing products?
1. Always have a doctor evaluate any skin discoloration you notice on yourself. Do NOT seek to treat it without having it looked at by an MD, preferable a dermatologist.
2. If hydroquinone is recommended, consider starting with an OTC product that contains only 2% hydroquinone. Allow 4-6 weeks to determine if the product is working.
3. Minimize sun exposure and wear a very good sunscreen, especially while using hydroquinone.
4. Do not allow peroxide to come into contact with skin treated with hydroquinone. It will cause a temporary staining of the skin.
5. Always stop using the product immediately if you observe you are having an adverse reaction to hydroquinone.
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