Hydroquinone 4 side effects



Hydroquinone is a skin-bleaching agent that is used to lighten areas of darkened skin such as freckles, melasma, age spots, and acne scars.

In New Zealand, hydroquinone is registered as a Pharmacy Only medicine in creams containing hydroquinone in concentrations up to 2%. Some doctors’ offices may sell other brands with concentrations up to 4%.

Before and after using hydroquinone for three months for melasma

How does hydroquinone work?

Hydroquinone works by decreasing the production and increasing the breakdown of melanosomes in melanocytes. It does this by inhibiting the activity of tyrosinase, the enzyme needed to make melanin.

How effective is hydroquinone?

In most cases, lightening of skin should be seen after four weeks of treatment. Sometimes it may take longer to see any change, but if no bleaching effect is seen after three months of treatment, you should stop using hydroquinone.

To increase the effectiveness of hydroquinone, you should stay out of the sun, or wear protective clothing and use an SPF15+ sunscreen when outdoors. Do not use sunlamps or tanning salons.

It is important to use hydroquinone regularly as directed until you achieve the desired bleaching, after which use as needed to maintain results.

How to use hydroquinone

  • Test for skin sensitivity before using by applying the cream to a small patch of hyperpigmented skin. If no redness or itching occurs within 24 hours, begin treatment.
  • Clean and dry the skin before applying a thin film of cream twice daily to the area(s) in need of bleaching. Rub into the skin well.
  • Apply just enough to cover the affected areas and avoid applying to normal skin, as this will lighten as well. Hence wash your hands after applying unless these are areas of treatment.
  • Do not apply near the eyes, mouth, and other mucous membranes.
  • Avoid using other medicated topical products (particularly peroxide products) in the same area at the same time unless directed to do so by your doctor.
  • When using non-medicated cosmetics, sunscreens, and moisturising lotions, apply hydroquinone first, then wait several minutes before applying them over the top.

Side effects of hydroquinone products

Hydroquinone cream is usually well tolerated. Some users may experience minor and temporary skin irritations including mild itching or stinging and reddening of the skin (irritant contact dermatitis). If these do not subside, stop using the cream.

Side effects that should warrant stopping the cream and seeking medical advice immediately include severe burning, itching, crusting, or swelling of treated areas (possible allergic contact dermatitis) and any unusual skin discolouration.

Prolonged use of hydroquinone has been associated with the development of exogenous ochronosis (a persistent blue-black pigmentation), especially in Africa, but this is rare. It might be due to other ingredients such as phenol, resorcinol and antimalarial agents, which are known to cause ochronosis.


Do not use benzoyl peroxide, hydrogen peroxide, or other peroxide products when using hydroquinone. Temporary dark staining of the skin may occur. If accidentally used together, wash the skin with soap and water to remove the staining.

Hydroquinone creams may contain sodium metabisulphite that may cause serious allergic reactions (including anaphylaxis) in certain susceptible people.

Hydroquinone should not be used in pregnancy or when breastfeeding.

New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

Hydroquinone is a topical skin-bleaching agent used in the cosmetic treatment of hyperpigmented skin conditions. The effect of skin lightening caused by hydroquinone is reversible when exposed to sunlight and therefore requires regular use until desired results are achieved. Various preparations are available including creams, emulsions, gels, lotions and solutions. It is available over the counter in a 2% cream and can be prescribed by your dermatologist in higher concentrations.

Mechanism: Hydroquinone produces reversible lightening of the skin by interfering with melanin production by the melanocytes. Specifically, inhibition of the enzymatic conversion of tyrosine to DOPA (dihydroxyphenylalanine) results in the desired chemical reduction of pigment. Ultimately, this causes a decrease in the number of melanocytes and decreased transfer of melanin leading to lighter skin.

Uses: Popularized by its usage as a photo-developer, hydroquinone can be used in any condition causing hyperpigmentation. Common conditions include melasma, freckles, lentigines, age spots and acne scars. Skin sensitivity to hydroquinone may be determined before treatment by applying a small amount of cream to the hyperpigmented area and noting any redness or itching. If no reaction occurs, initiate treatment. As a general rule, always ensure the area is clean and dry then apply a thin film to the lesion and rub it into the skin well. Hands should be washed after the application to avoid unwanted lightening of the fingers.

To maintain the desired affect, hydroquinone should be used concurrently with a strong sunscreen. Many preparations are available as a combination product. Lightening of the skin should be noticed within 4 weeks of initiation, if no change is seen in 3 months, contact your dermatologist for further recommendations.

Side Effects: Normally hydroquinone is very well tolerated, however side effects may be seen. These include dryness, irritation, pruritus, erythema, and a mild irritant contact dermatitis. Furthermore, remember to avoid contact with eyes and use sparingly on the face. Prolonged usage of hydroquinone has been associated with ochronosis, a blue-black pigmentation with caviar-like papules on the skin.

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The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician – patient relationship. If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed written permission is given by the American Osteopathic College of Dermatology.

Dealing with melasma can be a challenging experience. From small areas of discoloration to large, obvious skin hyperpigmentation, melasma can range from an annoyance to a worrying skin condition that affects your confidence and self-esteem.

Although melasma isn’t dangerous to your physical health, it can have serious effects on your emotional well-being. Several studies even show that melasma can even affect your social life, preventing you from having the confidence to form relationships and enjoy life to its fullest.

We’ve covered the causes, symptoms and effects of melasma in more detail in our complete guide to melasma.

There are numerous treatments available for melasma, ranging from topical creams to chemical peeling and microdermabrasion. Below, we’ve covered everything you need to know about one of the most popular melasma treatments on the market—hydroquinone.

What is Hydroquinone?

Hydroquinone is an organic compound that’s used to treat a variety of discoloration-related skin conditions. It’s a skin lightening agent that works by reducing your production of melanin. When used topically, hydroquinone can cause your skin to lighten in color.

Hydroquinone is widely used as a scar treatment. Applied topically, it can cause darkened scars to lose some or all of their extra pigmentation, causing them to blend in and match the color of the surrounding skin.

It’s also used as a treatment for skin hyperpigmentation caused by UV exposure (spending too much time in the sun) and inflammation.

Topical hydroquinone creams are available as prescription medication to treat melasma and other pigmentation-related skin conditions. You can also buy limited strength hydroquinone as an over-the-counter medicine in most pharmacies.

Does Hydroquinone Work for Melasma?

Hydroquinone is one of the most effective topical treatments on the market for melasma. It has been thoroughly tested in numerous studies, almost all of which show that it works effectively to reduce pigmentation and even out the blotchy, darkened patches of skin that melasma causes.

In one 2007 study, application of a cream containing hydroquinone and retinol led to “sustained improvements” in skin coloration in people with melasma.

Hydroquinone also performed well in a 2013 study, producing a measurable reduction in MASI scoring (Melasma Area and Severity Index, a scoring system used to assess melasma) over a period of 12 weeks.

In the same study, hydroquinone also produced better results than kojic acid cream—a popular over-the-counter treatment for melasma and skin hyperpigmentation.

In short, hydroquinone is scientifically proven to reduce the amount of skin discoloration caused by melasma. For most people, it produces a noticeable improvement after eight to 12 weeks of consistent use, although some people might see improvements in their skin sooner.

However, this doesn’t mean that hydroquinone is guaranteed to treat melasma completely on its own. For more severe cases of melasma, hydroquinone is often combined with a topical retinoid such as tretinoin.

For persistent melasma, it’s often used in combination with a retinoid and a corticosteroid. This obviously increases the risk of side effects occurring, as many corticosteroids can produce side effects when used over the long term.

How to Use Hydroquinone to Get Rid of Melasma

If you’ve been prescribed hydroquinone, the best approach is to follow the instructions provided by your doctor.

Applying hydroquinone is simple. It’s best to test yourself for sensitivity before you begin using hydroquinone regularly. To test your skin, apply a small amount of hydroquinone cream to your melasma-affected skin, then check for itchiness or redness over the next 24 hours.

If you don’t experience any itching, soreness or redness, you can start treatment by following the instructions below:

  • Before applying hydroquinone, clean the hyperpigmented skin. Make sure the skin is completely dry before applying any hydroquinone cream.
  • Apply a small amount of hydroquinone cream to the melasma-affected skin. It’s best to use just enough cream to cover the hyperpigmented area. Take care not to apply any hydroquinone cream to non-melasma skin, as it can potentially lighten its color.
  • Wash your hands thoroughly after applying the hydroquinone cream. Wait for the cream to fully dry before applying makeup, moisturizer, sunscreen or any other topical products.
  • Take care when applying hydroquinone cream near the eyes, nostrils and mouth. If your melasma-affected skin is close to these areas, consider using a cotton swab to apply the cream more precisely.
  • Avoid using other lightening products on skin you’re treating with hydroquinone, as it’s possible for combinations of lightening agents to cause redness and irritation. If you’ve applied too much hydroquinone, wash the excess away using soap and water.
  • Do not use hydroquinone if you are pregnant or breastfeeding. Right now, there simply isn’t enough scientific evidence to show that hydroquinone is completely safe to use in pregnancy.

On average, it takes four to eight weeks for hydroquinone to produce noticeable skin lightening results, meaning you’ll need to apply it consistently before your melasma-affected skin begins to lighten and match the rest of your face.

Is Hydroquinone Safe?

Hydroquinone has been in use for decades, with a good safety record and relatively few safety issues. However, like most other skin medications, excessive or improper use of hydroquinone can and often does cause side effects.

The most common side effects of hydroquinone are itchiness, redness, stinging and other forms of skin irritation. These are typically mild and temporary. Many hydroquinone users often notice mild, non-permanent irritation after applying the cream to their skin for the first time.

If you’re sensitive to hydroquinone, it’s also possible for the medication to cause a more severe form of allergic contact dermatitis, which could potentially involve more significant skin burning, itching and crusting. In some cases, hydroquinone can cause minor swelling.

If you experience these side effects, it’s best to seek medical advice and cease further use of hydroquinone cream.

Finally, hydroquinone use is linked to the development of ochronosis. This is extremely rare, with most cases occurring in Africa. Current research indicates that this might be caused by exposure to hydroquinone in combination with antimalarials and other substances.

In general, hydroquinone is a safe, effective medication that’s been successfully used to treat melasma and other skin conditions for decades.

Learn More About Melasma

Studies show that hydroquinone works well as a treatment for melasma, helping to reduce skin discoloration and make blotchy, uneven patches of skin more consistent. However, it’s far from the only treatment available for melasma and other pigmentation-related skin conditions.

Our guide to melasma goes into more detail on how and why melasma occurs, as well as the most effective treatments available for reducing hyperpigmentation and returning your skin to normal.

Looking for more skincare tips from the hers pros? Head on over to the blog.

Have you noticed more and more products on the shelves claiming to fade away age spots and freckles? A big business in Asia, skin lightening/brightening creams have hit our shores. There are a several effective ways to lighten skin, but they do have their risks. There is a lot of information to cover in one post so today I’m going to focus on the most popular skin-lightening ingredient, hydroquinone. Look for future posts regarding other popular skin lighteners.

What is hydroquinone?
Hydroquinone is proven to be one of the most effective skin-lightening ingredients available but also one of the most controversial. It works by decreasing the formation of melanin, the pigment in your skin that gives it color.

I s it safe?
Unfortunately, there doesn`t seem to be a clear consensus in the scientific community. In the US, the FDA generally recognizes hydroquinone to be a safe and effective ingredient (at the moment). However, due to more recent data suggesting that hydroquinone act as a carcinogen, the FDA is recommending further studies to be conducted by the NTP (National Toxicology Program) to evaluate the health related effects of hydroquinone. These studies have not yet been completed so the current safety status of hydroquinone in the US has not changed. However, many companies are looking for safer alternatives to hydroquinone.
The American Academy of Dermatology (AAD) does continue to cite hydroquinone as a way to treat dark spots as well as other skin disorders such as melasma (overproduction of melanin resulting in dark patches on the face). However, the AAD does warn that overuse of hydroquinone could lead to irritation and potential darkening of the skin.

In Europe, where regulations tend to be a bit different, hydroquinone has been banned. This reminds us of how different countries treat chemicals differently. For example, the US has banned the artificial sweetener cyclamate because of studies showing that it might act as a carcinogen, yet it is allowed in more than 100 other countries. Who’s right, who’s wrong? Unfortunately, even science isn’t always black and white.

Bottom Line
As of now, hydroquinone is considered safe in the US. If you have concerns, I’d suggest talking to your dermatologist to see what she recommends to deal with with your dark spots. Of course, one of the best ways to treat age spots is to not get them all. UV exposure is one of the biggest culprits of dark spot formation so be sure to wear sunscreen and minimize sun exposure to keep skin spot free! Also, if you ever have questions about what is in your beauty products – just look at the label. The beauty of ingredient lists is that you can read the package and decide for yourself if the product is right for you or not.

More on skin-lightening from the FDA and AAD

For more science based beauty tips check out the Beauty Brains! More from SELF:
Your Sunscreen Protection Guide
Best Products to Lighten Dark Spots
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Taking the Pulse of Hydroquinone Therapy: A Plea for Caution

For many consumers, hydroquinone is like an old friend who inexplicably turns on you. They may have used it for years, trusting that their dermatologist—or, frequently, some Internet pharmacy—would never recommend a product that could harm them.

But over time, some of these consumers develop new pigment problems in the areas where they have faithfully applied hydroquinone. The product they bought to lighten sunspots, melasma, or other hyperpigmentation paradoxically leaves them with tough-to-treat issues such as severe rebound hyperpigmentation and ochronosis.

Avoiding such side effects requires a shift in our approach to hydroquinone. Specifically, my research and clinical experience have convinced me that our patients should use hydroquinone for no more than four or five months at a time. Then we must give the skin a break and allow it to stabilize before deciding if another course of hydroquinone is warranted. I call this approach Pulsed Hydroquinone Therapy.

Medical Products Need Medical Supervision

I have always been a strong proponent of hydroquinone. Used in reasonable concentrations, under physician supervision, it is safe and effective for pigment problems ranging from chloasma, melasma and postinflammatory hyperpigmentation (PIH) and to prepare skin for treatment of less common concerns such as nevi of Ota and Huri which require pigment laser.

But over the last several years, the Internet has become inundated with discounted, medical-grade products that companies sell directly to consumers without proper medical supervision or sun protection.

Consumers want to save themselves a consultation fee or doctor visit. I see no problem with buying a simple moisturizer or broad-spectrum sunscreen online. But to continue treatment with hydroquinone (or other medical-grade skin formulations, for that matter) indefinitely, without the oversight and expertise of the dermatologist who originally prescribed it, often creates dermatologic disasters.

Following are the patterns I see increasingly in my clinical practice, and the reasons behind them.

Resistance. Some people who have been using hydroquinone in proper concentration of 4% (alone or in compounded formulations) find that their skin improves for a few months, and then the improvement stops. In my experience, this is particularly common after four to five months of satisfactory response in patients using hydroquinone for melasma.

In such cases, the bleaching effects of hydroquinone appear more pronounced in the areas not affected by melasma. Meanwhile, the dark spots of melasma show no further improvement. In fact, as the active melanocytes in the affected areas develop resistance to hydroquinone, the patient’s hyperpigmentation in these areas worsens.

That is what happened to a 58-year-old female patient from India who was diagnosed with melasma at our clinic in 2001 (see above, Patient 1). At that time, she was treated successfully with hydroquinone 4%, and hydroquinone mixed with retinoic acid, followed by a chemical peel to the papillary dermis. A decade later, after having obtained branded hydroquinone 4% and retinoic acid products from the web and the black market, she returned and was diagnosed with rebound severe melasma (epidermal and dermal) that did not respond but worsened by her continuous hydroquinone use.

To avoid such problems, I recommend that after no more than five months of hydroquinone application, all patients should cease using this drug for two to three months. This allows melanocytes to stabilize (so they can withstand external and internal factors that might otherwise increase their activity) and restore the skin’s natural melanin. During this phase, patients can use other lightening agents, then resume hydroquinone if necessary afterward.

Some dermatologists may choose to treat resistant melasma by increasing the hydroquinone concentration. Instead, I have found that patients respond well to aggressive application of hydroquinone (4%) plus retinoic acid, combined in equal parts. This combination tends not to bleach the skin, but to accelerate attainment of a more natural and even color tone. Once the skin’s color has evened out after up to five months of treatment, I have my patients discontinue use of this mixture and switch to retinoic acid alone for two to three months; then patients resume hydroquinone application if needed.

Photosensitivity, phototoxicity. We know that certain topical agents, such as retinoids, aminolevulinic acid, and some systemic medications (such as tobramycin/ TCN and hydrochlorothiazide). can increase skin sensitivity to sun exposure. Surprisingly, no one, to my knowledge, has ever considered hydroquinone to be a photosensitizer.

Some patients use hydroquinone indefinitely, thinking it will prevent unwanted pigmentation. But we now know that decreasing the amount of melanin in skin, as hydroquinone does, creates photosensitivity. Without proper sunscreen use (sun protection factor/SPF ≥ 30, frequent reapplication), photosensitivity leads to inflammation, which stimulates melanin production.

The sun can also affect the melanocytes directly, increasing melanin production and possibly leading to rebound pigmentation. Furthermore, phototoxic reactions can trigger a chemically altered bluish melanin compound that’s responsible for ochronosis, which is tough to treat because it involves deep pigmentary changes deep in the dermis associated with altered skin texture.

Physicians used to consider ochronosis as a condition that was limited to certain African tribes, and we believed that it stemmed perhaps partially from genetic causes, partially from prolonged hydroquinone use.

However, in the last few years, I have observed a higher incidence of ochronosis not only in African-Americans, but also in Caucasian, Asian, and Hispanic patients who have used various concentrations of hydroquinone, often for years on end. In these patients, ochronosis has occurred in the areas of the face that experience the most sun exposure.

One such patient I saw was a 39-year-old Caucasian female. She had a history of melasma, and underwent the following treatments, prescribed by various dermatologists, in the two years prior to presenting at our clinic with severe ochronosis: three peels consisting of azelaic acid, kojic acid, phytic acid, ascorbic acid, arbutin, and titanium dioxide (Cosmelan, Mesoestetic) in one year; eight intense pulsed light (IPL) treatments; three fractional laser resurfacing (Fraxel, Solta) sessions; six Jessner’s peels; and continuous use of hydroquinone 8% throughout the two years.

This case also serves as a reminder that when treating hyperpigmentation, we should not use exfoliative procedures, chemical peels, laser resurfacing, or other thermal rejuvenating devices as our first step. Rather, I recommend proper skin conditioning—using hydroquinone, hydroquinone plus retinoic acid, alpha hydroxy acids, antioxidants, and any disease-specific agents necessary—for four to six weeks before and after any procedure (once skin healing is complete). This helps to restore normalcy and functionality to the skin, and it improves the results from procedures.

Excessive HQ concentration. I am used to prescribing hydroquinone concentrations of 4%, and I have treated many patients who used high concentrations on their own or under the supervision of other physicians. Based on my observations and experience, such concentrations deliver no greater or faster results than hydroquinone 4%. On the contrary, concentrations of 6-12% tend to cause more recalcitrant hyperpigmentation, quicker resistance, and a higher rate of ochronosis.

Excessive hydroquinone concentrations may induce toxic or shocking effects on melanocytes, forcing them to regroup and increase their melanin production (resulting in rebound hyperpigmentation). Additionally, high concentrations of hydroquinone may provoke skin inflammation. Used on its own, hydroquinone is an inflammatory agent that can cause redness, itching, and allergic reactions. Inflammation leads to melanocyte hyperactivity, which overpowers hydroquinone’s ability to suppress tyrosinase, leading to the rebound hyperpigmentation.

Such was the case with a 66-year-old African-American female with history of melasma who was treated for seven years by other dermatologists (Patient 2). She used hydroquinone 8%, tretinoin (Retin-A, Valeant Dermatology), and desonide cream (Desowen, Galderma) for years. Dissatisfied with the results, she eventually was prescribed hydroquinone 12%, and her dermatologist added topical steroids to her regimen. Ultimately, her worsening condition prompted this dermatologist to refer her to our office, where she was diagnosed with rebound dermal and epidermal hyperpigmentation, ochronosis with severe irritation and sensitivity. We stopped the hydroquinone regimen immediately.

Hydroquinone combination formulations. In this regard, consumers can readily find products that combine hydroquinone with various ingredients such as retinoic acid, glycolic acid, vitamin C, and topical steroids. However, prolonged use of such products can worsen pigmentation and create additional issues. This is especially true of products that combine hydroquinone, retinoic acid, and steroids e.g., Kligman’s formula and the combination of hydroquinone, tretinoin, and fluocinolone acetonide (Triluma, Galderma). I have found that long-term use of such products can lead to skin atrophy, the appearance of telangiectasias, skin sensitivity, and, frequently, more stubborn pigmentation than the patient originally had.

The topical steroids in these formulations aim to suppress inflammation. This is critical because inflammation excites melanocytes, which stimulate melanin production. However, topical steroids only work on pigmentation induced by trauma or disease (PIH). In contrast, we must avoid prescribing topical steroids for patients with pigment problems not caused by inflammation, such as melasma.

Moreover, to avoid disrupting cellular function, these triple-combination products should not be used for longer than five to seven days, in accordance with their instructions. As an alternative, I prefer the combination of hydroquinone and retinoic acid without a steroid. It is safer, yet quite effective when used properly for three to five months with strict sun protection.

Retinoids Require Caution

As with hydroquinone, however, many medical-grade ingredients, such as retinoic acid and other retinoids, if used indefinitely, prove helpful for two or three months but can then cause continuous irritation. This irritation can lead to inflammation and create more damage as the skin builds resistance to the treatment.

The following patients’ experiences are typical in this regard.

Patient 3 (photo previous page), a 59-year-old Hispanic female with a history of melasma, acne, and scarring, was successfully treated in 1990 with topical creams, isotretinoin, and trichloroacetic acid peels. Her maintenance program included hydroquinone 4%and a hydroquinoneretinoic acid combination, as described above. About five years ago, she returned to the clinic with ochronosis, primarily on the left side of her face (because she drives long distances). She is currently being treated for her ochronosis.

Patient 4 (photo previous page) is a 57-year-old African-American female, seen 25 years ago for PIH and melasma. She responded well to a topical medication that included hydroquinone 4%, used daily, and hydroquinone mixed with retinoic acid in the evening. She also had a trichloroacetic acid peel down to the papillary dermis. Subsequently, she did not follow-up with her treatments, but eventually returned many years later. She had been using the hydroquinone medications continuously, and presented with ochronosis. I had her immediately stop the hydroquinone treatment; she did not desire to treat the ochronosis, saying it did not bother her.

Based on such cases, I now view retinoic acid as a tool for general skin repair; beyond that, it is not always an ideal agent. Patients generally find retinoic acid hard to tolerate long-term because the portion of the drug that is not absorbed for skin repair remains on the skin’s surface, which can provoke continuous reactions. Along with irritation, these reactions can include redness, dryness, and exfoliation. For some patients, these continuous reactions can even break down the skin’s barrier function, creating skin sensitivity. These side effects explain why many patients abandon treatment with retinoic acid.

To avoid these problems, I now recommend that patients use retinoic acid for no longer than five months. That is sufficient time to accomplish general skin repair, without risking long-term skin reactions. After five months, I switch my patients to an agent with specific skin repair functions, such as retinol. For normal to dry skin, it improves barrier function while also stimulating and stabilizing the skin. Because retinol is converted intracellularly to retinoic acid, it leaves no free, unused retinoic acid on the skin’s surface to provoke reactions.

All the cases outlined above share key similarities. Although each patient began treatment under a doctor’s care, they later purchased medical-grade hydroquinone, and other medical-grade ingredients, through online and other unauthorized sources selling at deep discounts. The ready availability of these products, often from websites owned by physicians, pharmacies or other retailers, enabled consumers to use these products without physician oversight for more than five years continuously. Accordingly, I oppose selling medical-grade products on the Internet if they are being offered for the purpose of treating skin conditions without medical supervision. I believe the FDA should intervene to halt such practices.

Conversely, I believe that formulations combining hydroquinone with botanical anti-inflammatory agents and antioxidants that can suppress skin inflammation induced by factors such as sun exposure, hormones, and diet are very helpful in treating hyperpigmentation. Even systemic inflammatory agents such as ibuprofen can accelerate a patient’s response to hydroquinone. They do this by arresting or suppressing chronic skin inflammation.

However, in my view, adding vitamin C or glycolic acid to hydroquinone offers no scientifically documented extra benefits. In fact, vitamin C and glycolic acid can irritate the skin, which leads to inflammation and worsening of existing hyperpigmentation (rebound hyperpigmentation).

Pulsed Regimen Reduces Risks

In conclusion, hydroquinone is safe and effective when used as directed by a physician for a wide variety of pigmentation problems. To increase its efficacy and avoid unwanted side effects, dermatologists should consider the following protocol:

  • Prescribe hydroquinone concentrations no higher than 4%.
  • Require patients using hydroquinone to use proper sun protection.
  • Continue prescribing hydroquinone for no more than four to five months.
  • Allow the skin to rest and restore itself for two to three months after hydroquinone therapy.
  • Resume hydroquinone therapy, if needed, only after such a break.

Adopting the pulsed approach will spare our patients from the disfiguring and needless side effects of extended, self-directed use of hydroquinone.

Undercover Health Officials Identify Skin-Lightening Cream Containing Mercury

http://en.wikipedia.org/wiki/File:Pouring_liquid_mercury_bionerd.jpg SAN FRANCISCO (AP) — California health officials became alarmed when a 39-year-old Mexican-American woman in Alameda County was diagnosed with mercury poisoning, giving her headaches, numbness, depression and forgetfulness.

Scouring her home for the likely culprit, they determined that an illegal skin-lightening cream smuggled in from Mexico was to blame.

Health investigators are currently going undercover in some San Francisco Bay Area ethnic communities to root out the foreign-made products whose pigment-busting ingredient can have damaging side effects.

The unlabeled jars of mercury-laced cream are typically used to lighten skin, fade freckles and age spots, as well as treat acne.

The investigators are working with health and beauty workers in the immigrant communities of San Francisco, Oakland and San Jose to hunt for the skin creams in shops and at swap meets, while encouraging families to dispose of the products safely.

The California Department of Public Health sent out a medical alert to health care professionals earlier this month, calling on them to notify the state of potential mercury poisoning cases and to ask their patients to stop using their creams.

California health officials worked with the Centers for Disease Control and Prevention to write a report in January that indicated at least 22 people in five households in California and Virginia had shared skin-lightening creams made in Mexico. Twelve people in California and 10 in Virginia had mercury in their bloodstream; the highest levels were among women who typically used the cream at least twice a day.

Officials would not release the names of the people in the study that began in 2010, saying they wanted to protect their privacy. After the study began, samples of the cream tested in Virginia showed that it contained 5 to 6 percent mercury, according to state health officials there.

The Minnesota Department of Health warned residents last year that skin lightening products being sold in African, Asian, Latino and Middle Eastern communities in the Twin Cities contained dangerous levels of mercury. The Environmental Protection Agency has warned about the presence of the heavy metal in creams sold in the Chicago area.

California health officials believe there likely are many more people who are using the cream and are unaware of its dangers. The products often enter this country hidden in luggage, or are smuggled across the border. Then the creams are sold under the counter at shops and pharmacies that cater to ethnic communities whose cultural norms lean toward lighter skin as a marker of beauty.

“That is the largest incidence that we’re aware of here in California,” said Dr. Rupali Das, chief of the exposure assessment section at the California Department of Public Health, of the Alameda County cases.

Mercury poisoning can harm the body’s nervous system and kidneys, and even affect personality, health officials say.

The CDC report found that six of those in the study had symptoms consistent with chronic exposure to mercury, including numbness, tingling, dizziness, forgetfulness, headaches and depression. All reported getting their creams either directly from Mexico or from relatives in Virginia who had purchased the creams in Mexico.

Twelve of those with mercury levels found in their urine had not used the creams, but likely were exposed to it by hands that still carried traces of the heavy metal. The youngest among those was an 8-month-old baby.

“It is most harmful on the nervous system and the kidneys and then can also cause changes in personality and a variety of other problems,” said Das, a co-author of the CDC report. “We’re concerned about the harmful effects that mercury can have on children. It can delay their development and they might not catch up — ever.”

The mercury blocks melanin, which gives skin and hair its pigmentation.

But even mild to moderate toxicity due to inorganic mercury can include irritability, difficulty with concentration and memory loss. Insomnia and weight loss can also be side effects and so can tingling in hands, feet or around the lips.

Some of the creams collected and analyzed by California medical officials contained mercury levels 20,000 to 56,000 parts per million. The U.S. Food and Drug Administration allows only trace levels of mercury in creams, or less than 1 part per million.

Latinas, Asians and Filipinas were the predominant users of the creams in California, Das said. For some members of those cultures, traditionally darker skinned people were the laborers who worked outside in the sun, she said, while lighter skin was often considered a symbol of higher social status and wealth.

The family in Alameda used unlabeled face cream in a white plastic jar that was produced in Jalisco or Michoacan, Mexico. They got the cream from a relative in Virginia who has been purchasing the jars from an individual in Mexico.

The highest mercury levels were in the woman and her 4-year-old child. The woman had 100 times the safe level.

The California Department of Public Health advisory said the woman experienced mild to moderate symptoms of tingling in her hands and lips, dizziness, forgetfulness, headaches, depression and irritability and anxiety.

Her 4-year-old child, whose mercury levels were 25 times higher than normal, appeared to have no serious symptoms. Investigators determined the woman used the cream twice a day and her husband once a day for about three years to fade freckles and age spots.

The CDC says inorganic mercury can be ingested, inhaled or absorbed through the skin; then excreted in urine, sweat and breast milk. The half-life of inorganic mercury is one to two months, so mercury levels can increase with repeated application of the creams.

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Whatever your complexion, it’s important to use products that will help your skin and not damage it. But as you wade through the beauty aisles, the U.S. Food and Drug Administration cautions that you should avoid skin creams, beauty and antiseptic soaps, and lotions that contain mercury.

How will you know if mercury’s in the cosmetic, especially one that’s marketed as “anti-aging” or “skin lightening”? Check the label. If the words “mercurous chloride,” “calomel,” “mercuric,” “mercurio,” or “mercury” are listed on the label, mercury’s in it—and you should stop using the product immediately.

The products are usually marketed as skin lighteners and anti-aging treatments that remove age spots, freckles, blemishes, and wrinkles. Adolescents may use these products as acne treatments.

Jason Humbert of FDA’s Office of Regulatory Affairs says these products usually are manufactured abroad and sold illegally in the United States, often in shops catering to the Latino, Asian, African, or Middle Eastern communities. They are promoted online on social media sites and sold through mobile apps. Consumers may also have bought them in another country and brought them back to the U.S. for personal use, he adds.

If the ingredients aren’t listed and there is no product label, don’t assume it’s fine. Federal law requires that ingredients be listed on the label of any cosmetic or nonprescription drug, so do not use a product that doesn’t have a label. In addition, don’t use drugs or cosmetics labeled in languages other than English unless English labeling is also provided. That’s also a sign that the product may be marketed illegally.

“Even though these products are often promoted as cosmetics, they also may be unapproved new drugs under the law,” says Linda Katz, M.D., director of FDA’s Office of Cosmetics and Colors. FDA does not allow mercury in drugs or in cosmetics, except under very specific conditions where there are no other safe and effective preservatives available – conditions that these products do not meet.

Sellers and distributors who market mercury-containing skin whitening or lightening creams in the U.S. may be subject to enforcement action, including seizure of products, injunctions, and, in some situations, criminal prosecution.

Dangers of Mercury

Exposure to mercury can have serious health consequences. The danger isn’t just to people who use mercury-containing products but also to their families, says Arthur Simone, M.D., a senior medical advisor at FDA.

“Your family might breathe mercury vapors released from these products. Your children might touch washcloths or towels that are contaminated with mercury. It could be as simple as touching someone’s cheek or face,” Simone says.

Some people – including pregnant women, nursing babies and young children – are especially vulnerable to mercury toxicity, he adds. Babies may be particularly sensitive to the harm mercury can cause to their developing brains and nervous systems. Newborns who nurse are vulnerable because mercury is passed into breast milk.

Signs and Symptoms of Mercury Poisoning

  • irritability
  • shyness
  • tremors
  • changes in vision or hearing
  • memory problems
  • depression
  • numbness and tingling in hands, feet or around mouth

Source: Agency for Toxic Substances and Disease Registry (www.atsdr.cdc. gov/PHS/PHS.asp?id=112&tid=24)

Tracking Skin Products Containing Mercury

In the past few years, FDA and state health officials have discovered numerous products that contain mercury, and there have been cases in which people exposed to such products have had mercury poisoning or elevated levels of mercury in their bodies. FDA has an import alert in place that lets our field staff know that the agency has enough evidence or other information to refuse admission of shipments of mercury-containing skin products.

But this is only a partial solution, Humbert says.

“Many of these products are coming into the country through illegal channels,” he says. “That’s why it’s so important for consumers and sellers to know about the dangers of possible mercury poisoning associated with the use of these skin products.”

How to Protect Yourself

Thoroughly wash your hands and other parts of your body that have come in contact with products that contain mercury.

Contact your health care professional or a medical care clinic for advice. If you have questions, call your health care professional or the Poison Center at 1-800-222-1222; it is open 24 hours a day.

Before throwing out a product that may contain mercury, seal it in a plastic bag or leak-proof container. Check with your local environmental, health, or solid waste agency for disposal instructions. Some communities have special collections or other options for disposing of hazardous household waste.

Generic Name: Hydroquinone (HYE droe kwin one)
Brand Name: Aclaro, Alphaquin HP, AMBI Fade, Blanche, EpiQuin Micro, …show all 18 brand names.Esoterica Daytime, Esoterica Facial, Esoterica Fade Nighttime, Esoterica Sensitive Skin, Exuviance Lightening Complex, Hydroquinone Time Release, Melpaque HP, Melquin 3, NeoStrata HQ Skin Lightening, Remergent HQ, Skin Bleaching, Skin Bleaching-Sunscreen, TL Hydroquinone

Medically reviewed by Drugs.com. Last updated on Oct 12, 2019.

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Uses of Hydroquinone:

  • It is used to lighten the skin where there are changes in color.

What do I need to tell my doctor BEFORE I take Hydroquinone?

  • If you have an allergy to hydroquinone or any other part of hydroquinone.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

This medicine may interact with other drugs or health problems.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take hydroquinone with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Hydroquinone?

  • Tell all of your health care providers that you take hydroquinone. This includes your doctors, nurses, pharmacists, and dentists.
  • After stopping hydroquinone, some of the color change may come back.
  • If you have a sulfite allergy, talk with your doctor.
  • This medicine may cause harm if swallowed. If hydroquinone is swallowed, call a doctor or poison control center right away.
  • Avoid sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun.
  • Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using hydroquinone while you are pregnant.
  • Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

How is this medicine (Hydroquinone) best taken?

Use hydroquinone as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • Do not take hydroquinone by mouth. Use on your skin only. Keep out of your mouth, nose, and eyes (may burn).
  • Wash your hands before and after use. Do not wash your hands after use if putting this on your hand.
  • Clean affected part before use. Make sure to dry well.
  • Put a thin layer on the affected skin and rub in gently.
  • Practice good skin care and avoid the sun.
  • Do not use coverings (bandages, dressings, make-up) unless told to do so by the doctor.
  • Do not use on irritated skin.

What do I do if I miss a dose?

  • Put on a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not put on 2 doses or extra doses.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Very bad skin irritation.
  • Change in color of skin to blue-black.
  • Itching.
  • Blisters or sores.

What are some other side effects of Hydroquinone?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

  • Dry skin.
  • Skin irritation.
  • Redness.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Hydroquinone?

  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

Consumer information use

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about hydroquinone, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

More about hydroquinone topical

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  • Drug class: topical depigmenting agents

Consumer resources

  • Hydroquinone topical
  • Hydroquinone with Sunscreen Cream and Gel

Other brands: Hydroquinone and Sunscreen, Lustra, Alphaquin HP, Palmers Skin Success Eventone Fade, … +21 more

Professional resources

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Related treatment guides

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Hydroquinone for Skin Lightening

Hydroquinone has a reputation as a controversial ingredient for skin, yet for more than 50 years it’s been established as the most effective ingredient for potentially fading uneven skin tone, brown or dark spots, and lightening skin.

As always, we turn to the research to reveal why considering hydroquinone for skin lightening is a logical approach depending on what you’re trying to achieve. In the long run, hydroquinone is considered the best ingredient for skin lightening and that hasn’t changed over the years.

Of course, if you decide hydroquinone isn’t the ingredient for you, we have some alternative options with some impressive research behind them for skin brightening that you can consider trying.

The Hydroquinone Controversy

Hydroquinone’s controversial reputation stems from when it was banned in South Africa many years ago. As it turns out, the products in question were found to contain mercury and glucocorticoids, among other caustic and illegal contaminants—a highly probable cause of the side effects seen.

Unfortunately countries in the European Union followed suit chiefly on the basis of these reports, despite the fact that when properly formulated, hydroquinone is not a harmful ingredient. In contrast, there’s abundant research showing hydroquinone to be safe and extremely effective.

Another issue is the extremely rare association with long term use of hydroquinone (especially in high concentrations or from adulterated products) and a skin disorder called exogenous ochronosis.

Ochronosis is a reaction where the skin darkens in areas where the product was applied. If you’re concerned about this risk, you can turn to the alternatives to hydroquinone for skin brightening we list below. However, if you still want to consider hydroquinone, then we strongly encourage you to stop using it immediately if you see any amount of skin darkening taking place and consult your physician.

How Hydroquinone Works

Hydroquinone helps limit skin from creating an excess amount of melanin, which is what gives skin its color. Too much melanin clustered together leads to the brown spots. Hydroquinone steps in to interrupt this process, causing brown spots to gradually fade.

Over-the-counter hydroquinone products can contain up to 2% concentrations, with 2% being the most effective OTC amount. 4% concentrations of hydroquinone (and sometimes even higher) are available by prescription only and can be helpful for stubborn or advanced brown or dark spots.

With daily usage, you can reasonably expect a hydroquinone-based skin-lightening product to produce visible results within 2-3 months (8-12 weeks) of consistent use. We know that sounds like a long time, but keep in mind those brown spots didn’t happen over night; they took several years to form and then show on skin’s surface.

Getting the Most Benefit from Using Hydroquinone

Sun protection (and, some dermatologists would stress, sun avoidance) is a key part of any skincare routine, but this is especially important if you’re going to use skin-lightening products. You won’t get the results you want without being obsessive about applying an SPF 30 or greater sunscreen 365 days a year, rain or shine. If used as directed with other sun protection measures, this decreases the risk of skin cancer and early skin aging caused by sun.

Don’t leave home without it, because it’s important to reapply as needed (which is more often than you think, especially after washing your hands). We wish this wasn’t so rigid, but it’s what the research has shown is necessary to take the best possible care of your skin when brown spots are the concern.

It’s essential that your hydroquinone product be packaged in an opaque container that minimizes air exposure. Hydroquinone degrades in the presence of air, which means it should not come packaged in a jar. Once the jar is opened it lets air in, the hydroquinone loses its potency.

At Paula’s Choice Skincare, we offer two hydroquinone products, strategically packaged for maximum results from this over-the-counter solution. If you have for normal to oily/combination skin, you’ll see impressive results with our RESIST Triple-Action Dark Spot Eraser 2% BHA Gel. If you have normal to dry skin, our RESIST Triple-Action Dark Spot Eraser 7% AHA Lotion is the ideal choice.

Natural Alternatives to Hydroquinone

Plant extracts such as Mitracarpus scaber (madder) extract, Uva ursi (bearberry) extract, Morus bombycis (mulberry), Morus alba (white mulberry), and Broussonetia papyrifera (paper mulberry) are indeed good options to consider for natural skin brightening ingredients.

However, it’s interesting that all of these break down into hydroquinone when absorbed into skin, which explains why they have a positive effect.

Another natural alternative is arbutin, which also breaks down into hydroquinone when absorbed into skin. While these alternatives are certainly viable options, if you’re concerned about hydroquinone, this is important information for you to know.

Whether or not you use a hydroquinone-based skincare product is of course up to you—what’s abundantly clear is that it’s a well-researched ingredient, incredibly effective for its intended purpose, and as it the top of class in terms of effectiveness. Now that you’re armed with the facts, you can decide what’s best for your skin!

Learn more about skin brightening.

Learn more about dark spots.

References for this information:
Dermatology and Therapy, December 2014, pages 165-186
The Journal of Clinical and Aesthetic Dermatology, August 2014, pages 13-17
Journal of the European Academy of Dermatology, August 2006, pages 781-787
Journal of the European Academy of Dermatology and Venereology, July 2009, pages 741-750

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