Hydroquinone

What skin conditions does hydroquinone treat?

This powerful pigment inhibitor can treat-

• Melasma or pregnancy associated pigmentation
• Sun induced spots such as freckles
• Skin pigmentation following acne
• Brown scars
• Pigmentation after chicken pox or shingles
• Some forms of dark undereye circles

*Hydroquinone does not work well for racial pigmentation, dark underarms-groin-neck areas, lips, genital areas. For these conditions you should talk to your medical dermatologist for other options.

How fast does hydroquinone work?

Effects are generally seen after 3-4 weeks. The reason for this delay is that hydroquinone BLOCK pigment production however the initial pigmentation needs to be exfoliated from your skin. This is why many preparations contain in-built exfoliators including citric, glycolic, lactic & salicylic acids.

The majority of HQ creams also contain ascorbic acid which can further reduce pigmentation as well as providing antioxidant properties to reduce UV damage & stabilize HQ.

Can I use hydroquinone daily?

Yes, if tolerated. A moderate strength hydroquinone cream can be safely used daily for 4-6 months. Start off with application every second day, increasing as tolerated.

Hydroquinone is best used at night, either as a stand alone topical or combined with ascorbic acid, niacinamide, or retinol-retinoids. Formulation will depend on skin sensitivities, skin color, duration of treatment & most importantly the diagnosis.

How do I properly use hydroquinone?

Correct application is paramount for both safety & efficacy. Be precise with your application of HQ. Instructions as follows-

• Preferable application at night after bath/shower/wash
• First time users start every second night, increase as tolerated
• Sensitive skin patients, dilute HQ with moisturizer
• Apply to selective pigmented areas with a cotton tip applicator for accuracy
• Apply 2-4 hours before sleep to reduce ‘smudging’ on pillow case
• Increase or decrease use based upon side effect profile of your HQ formulation
• For super sensitive skin, consider short contact therapy, more on that shortly

If you have any questions, please direct them to your assigned therapist or nurse.

Is hydroquinone safe?

The use of hydroquinone is considered safe by most mainstream dermatologists, however there are some caveats-

• This compound should not be used in pregnancy as it is not a category A drug. A sensible substitute is azelaic acid.
• Concentration of HQ should ideally be 8% or lower.
• Allergies are uncommon, whilst skin irritation is common. There are fundamental differences between irritation & allergic reactions.
• Duration of continuous use should be less than 6 months (maximum duration). A break of several months is recommended to reduce side effects such as exogenous ochronosis (dermal pigment) & tachyphylaxis.
• There are concerns of carcinogenic potential in some regulating bodies, especially in Asia.

Can hydroquinone be used on other parts of the body, apart from the face?

Yes, you can treat focal areas such as spots & dots on the body & face. HQ is not designed to be applied to the entire face or to the entire body part (such as the arms or legs). Be guided by your skin care specialist.

Can hydroquinone be used to treat dark circles under the eyes?

HQ topicals have demonstrated success in lightening under-eye hyperpigmentation including dark circles. Strengths in over-the-counter preparations start at 1%-2% (recommended concentration for the super sensitive under eye area). I also combine peels & lasers with hydroquinone or retinoic acid for an added lightning benefit.

Note: HQ can only treat some forms of dark circles where pigment is the contributing factor.

Does HQ remove dark spots?

Hydroquinone is the gold standard for dermatologists for the treatment of dark spots including melasma & post inflammatory hyperpigmentation. Note, however, that may not be the best choice for everyone. The most important aspect of management is to identify the cause of dark spots & come up with a safe & effective treatment plan.

Hydroquinone is combined with lasers & chemical peels to amplify the results & to reduce the side effects of long term hydroquinone use.

What are the side effects of hydroquinone use?

The most common side effect is irritation, namely red stinging, burning & itchy skin. This happens if you have sensitive skin &/or if the HQ concentration is too high.

It is paramount you understand your skin’s threshold & know how to properly apply HQ- see application guidelines. Other side effects include-

• Dermatitis
• Dryness
• Redness.
• Inflammatory reaction (common)
• Allergies (very rare)
• Tachyphylaxis (when HQ doesn’t work)
• Ochronosis (when one gets darker skin from HQ use long term)

How do I continue hydroquinone if I experience skin irritation?

It is vitally important to decipher the difference between skin irritation and skin allergies. The latter requires you to cease this medication, whilst skin irritation can be reduced with the following methods-

• Use every second night.
• Apply an equal amount of HQ (half of what you would normally use) with a moisturizer of your choice. This essentially dilutes the solution.
• Apply accurately to the affected area.
• Apply a moisturizer 30 minutes before & after steps one to three.
• Consider short contact therapy, apply for 30 minutes then wash off.

Allergic reactions can be identified via a ROAT test or repeat open application testing. Use a small amount of HQ on your inner arm. Apply daily. If you have a brisk reaction, chances are you may be allergic to hydroquinone.

Can I use vitamin C & hydroquinone together?

Ascorbic acid is probably the best compound to be combined with HQ. Hydroquinone with Vitamin C is especially effective because the vitamin also provides protection against sun damage & oxidation, in addition to keeping HQ in a stable formulation.

In most cases we have scripted ascorbic acid with your HQ prescription, so you do not need to add vitamin C. This concentration is less than the normal 10-20% L-ascorbic acid formulas.

Is retinol better than hydroquinone?

For overall improvement in photoaged skin, enlarged pores, fine lines & wrinkles, tretinoin and other retinoid drugs are a better choice than hydroquinone. But if you need to treat specific age spots & pigmentation, hydroquinone is preferable.

We do prescribe a combination of retinoids & hydroquinone in a formulation called Kligman’s. The downside of this formulation is that it increases the skin irritation of both molecules, that is why it also contains a steroid preparation.

What is the fastest way to lighten skin?

A chemical peel gives the fastest response. Peels can reduce pigmentation within a few days however maintenance is essential for continued clearance.

Our favorite peels include Cosmelan, Dermamelan, Jessner & TCA as well as super strength retinoic acid peels. We are selective as to who I peel, as rebound is always an issue, especially in the management of melasma.

What is the best way to lighten skin?

A combination of pico lasers & prescriptive skin care gives the best results. Unlike Cosmelan peels, lasers do not have any recovery. Our bespoke settings & skin care formulations sets us apart from beauty & cosmetic clinics.

What other products can I use to lighten skin, apart from Hydroquinone?

To date HQ remains as one of the most effective molecules to reduce pigmentation. Having said this, HQ can not be used long term due to the risk of tachyphylaxis & exogenous ochronosis (HQ stops working, HQ causes paradoxical darkening). On this basis our protocol is rotational therapy with the following pigment correctors & exfoliators-

• Kojic Acid
• Lactic, Glycolic, Citric Acid & Salicylic Acids
• Retinoic Acid
• Arbutin
• Soy
• Bearberry
• Flavonoids
• Niacinamide
• Ascorbic Acid
• Azelaic Acids
• Other organic botanicals

The ideal formulation depends on your skin type, sensitivities & clinical findings. Be guided by your skin care expert. We employ non-HQ pigment inhibitors as third line therapy or rotational therapy.

What is TriLuma & is it better than hydroquinone?

TriLuma cream is used to treat melasma. It contains hydroquinone, tretinoin & a corticosteroid preparation. HQ concentration is less than our formulation at 4%.

A retinoid is formulated with hydroquinone to amplify the results of individual ingredients whilst steroids reduce the skin irritation from tretinoin & hydroquinone. This cream is effective for melasma, however its use should not extend beyond 8 to 12 weeks.

Efficacy is not related to formulations, as the rate limiting factor is your skin’s ability to tolerate TriLuma.

Is Cyspera better than hydroquinone?

Cyspera contains 5% cysteamine. Marketed as a potent anti-pigment ingredient with efficacy rates of nearly 90%, the real world experience is underwhelming. It does however have an advantage over HQ as long term side effects are not seen.

Modulation of use is paramount for efficacy as skin irritation is higher with cysteamine, hence the practice of short contact therapy.

How do I incorporate hydroquinone in my daily skin care routine?

A sensible skin care routine that involves hydroquinone goes something like this;

AM: Cleanser, SPF, Make up, with the option of antioxidants (Ferulic acid, Ascorbic Acid, Tocopherol)

PM: Cleanser, Hydroquinone* 2-5% +/- Retinoic Acid, with low concentrations of lactic, glycolic, citric or salicylic acid. This program is safe for up to 6 months. HQ is then rotated with the following; Kojic acid, licorice root, flavonoids, niacinamide,soy, arbutin, organic botanical pigment inhibitors, citric, lactic, glycolic, salicylic acid. Cysteamine is another non-HQ pigment inhibitor.

*Option to increase to twice a day application if tolerated.
** Sounds complex? Be guided by your skin care expert