Although hydroquinone (HQ) has been the mainstay ingredient in products that are known to lighten and fade brown facial discoloration and Melasma, there are some very valid concerns regarding the potential for overusage.
Hydroquinone is available in over the counter products up to 2% concentration. Prescription strengths (or cosmeceuticals) may typically come in 4 to 8% or higher formulations.
We have long been concerned over the lack of discretion and monitoring provided to patients that are using hydroquinone products. The concern is that prolonged use or use of this strong ingredient in high percentages may lead to irreversible skin changes. More concerning with extended use and overuse is the possible link with certain cancers. Before becoming too alarmed, these potential adverse events are generally viewed by most experts as being small in comparison to the well known benefits hydroquinone offers….when used safely.
Negative side effects which are much more common and seen in our practice usually involve medium to darker skin types. For example, many patients come to us after following a regimen of retinoids and hydroquinone (provided at other medical offices) to fade pigmentation associated with stretch marks, melasma, or sun spots. Often, these patients are not provided with basic education about the side effects of hydroquinone nor monitored for how their skin responds to this treatment regimen. Therefore, it is not unusual to see a worsening of the condition or even an entirely different, negative response.
When skin is in a prolonged state of irritation, as can happen with overusage of retinoids and hydroquinone, it not only “hangs onto” pigmentation, it may also worsen the condition by developing post-inflammatory hyperpigmentation (redness or brown discoloration associated with an inflamed skin and tissue response.) This then creates a cycle wherein the patient uses more product to counteract what is happening but only worsens the situation. This is commonly seen in those that are medium to darker skin types.
A far more concerning adverse outcome would be an uncommon, but very serious, condition called ochronosis. This presents as a grayish or dark discoloration that develops as a result of permanent damage to the skin linked to over-use of hydroquinone products.
Ochronosis – Emedicine/Medscape.
In summary, hydroquinone is a good option for all skin types when used in conjunction with safe protocols, monitoring by the one dispensing the product, and good patient education. If one is not tolerating topical products for the purpose of fading brown discoloration, class IV medical lasers may be a good option.
Lori Haney, RN, MEP-C
Certified Medical Laser Safety Officer