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Hydroquinone is a lightening or bleaching medication that has been added to over-the-counter and prescription products for many years. It offers the ability to “bleach” and even out skin tone. Most people who use hydroquinone-containing products want to treat skin problems that cause brown spots such as melasma, sun damage, freckles, or scars. Hydroquinone works by slowing down the skin’s production of melanin (or pigment), so it won’t change the underlying color of your skin, but will help overly pigmented areas fade to your normal skin tone.
At Celibre Medical, we often see the following scenario in patients with darker or ethnic skin. Many hydroquinone creams are used with or even combined with retinoids (Retin-A) into a single product. These two compounds together can cause irritation. Ethnic skin, when inflamed and irritated, frequently responds by making more pigmentation. Although their skin feels irritated, many patients see this increased discoloration and use even more of the cream to fight it! This leads to a vicious cycle of irritation, inflammation and a worsening of a pigmentation problem. This unfortunate cycle could have simply been avoided by some up-front education on how hydroquinone works and its typical effects on the skin. The way to avoid this problem is to use the product conservatively without leaving dabs on the skin for long periods.
A more serious potential concern with the use of hydroquinone on darker, ethnic skin is the problem of ochronosis. In this condition, hydroquinone-containing creams (usually higher strength, 8% to 10% prescriptions) trigger the gradual development of a blueish-grey discoloration in the skin. This side effect can be avoided by using no higher than 8% hydroquinone, taking breaks from the medication use every three months and avoiding sun exposure when using the medication.
If you are considering using hydroquinone, take the time to speak with your medical practitioner and discuss all the possible effects (good and bad) of hydroquinone before you use it. Hydroquinone is a powerful medication that has the potential to do good, but can cause problems if not used correctly or without proper follow up care.
It’s important to remember that hydroquinone may not be the best choice for your pigmentation problem. Class IV medical lasers also offer an effective treatment option (especially for sun damage) if you’ve failed hydroquinone or are not a good candidate for it.
Lori Ishii Haney, RN, MEP-C
Certified Medical Laser Safety Officer