Dark Side of Hydroquinone

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Quest For Even Skin Tone

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Aging initiates a battle to maintain the smooth and supple skin with which we were born. Enemies include hyper­pig­menta­tion from acne, ingrown hair, sun damage, scars, freckles, age spots, and melasma. Skin darkening may be influenced by gender, trauma, genetics or hormonal changes.

With such an onslaught of skin attacks, doctors of dermatology are often tasked to even out mottled complexions. Though less popular today, some dermatolo­gists may prescribe hydro­quinone, which has been considered one of the most effective skin lightening agents for many years. But there are important facts to consider before use.

Hydroquinone Conditional Ban

The FDA-approved prescrip­tion drug skin-lightener, hydroquinone (up to 4 percent), was grand­fathered into acceptance because it was widely used to impede melanin production before inception of the FDA. Para­doxically, in 2006 the FDA proposed an unenforced U.S. ban on over-the-counter (OTC) sales of cos­metic products containing up to 2 percent hydro­quinone. This was based largely on a 1994 report published by OSHA in the Journal of the American College of Toxicology (now known as the International Journal of Toxicology). Any skin-lightening products containing hydroquinone are considered new drugs, according to the FDA regulations. They require FDA approval before being sold to the public and are only available with a doctor’s prescription.

Dangers of hydroquinone

Preliminary findings indicate, “hydroquinone is mutagenic and has cancer-causing potential.” The OSHA addendum states that “hydroquinone is a potent cytotoxic agent that causes muta­tions and altera­tions to DNA, and that it should not be used in any leave-on type of product; it is safe for rinse-off products when used in concen­tra­tions less than 1%.” Because of its cytotoxic impact on the melano­cytes within the skin, it is said to disrupt basic cellular processes, including DNA and RNA synthesis. Europe, Asia and several African countries also have strict guidelines on hydroquinone use.

With lack of FDA approval, alternatives to hydroquinone cannot be labeled skin-lighteners or whiteners, so the industry often uses the term “brightener.” Products range from prepara­tions with various hydroxy acids to red algae. The newest agents to fight melanin formation are the peptides, which appear to brighten sun-induced hyper­pig­menta­tion in half the time of other skin brighteners.

Challenges of Hydroquinone

Within the skin, melanin regulates pigmenta­tion with racially based differences. It is more difficult to lighten skin in individuals with darker complexions due to the enhanced ability of darker skin to produce melanin. Post-inflammatory hyper­pigmenta­tion occurring from skin trauma in dark-skinned indivi­duals is a challenge because skin lighteners must penetrate deep within the stratum basale—deepest layer of the five layers of the epidermis. More visible pigmenta­tion is evident among people with lighter skin. OTC skin-brighteners are more successful among this population.

Lighten Skin With Hydroquinone?
Anatomical skin pigmenting: Dark-skinned people do not have more melano­cytes (melanin-producing cells than lighter-skinned people. But their melanocytes are more productive, says Dr. Martin Weinstock, a professor of dermatology and epi­demio­logy at Brown University.

Mitigating the Effects of Hydroquinone

As might be expected, higher doses of hydroquinone generally produce more rapid results. Hydroquinone can also irritate the skin of some people, triggering redness or more severe pigmenta­tion called onchro­nosis. Initial use is therefore recom­mended in a small inconspicuous area.

Treatment involves a juggling act to lighten pigmentation, stop future sun damage, suppress inflammation (usually with cortisone) and even out skin tone. Ideally, damaged skin is exfoliated, new skin is protected from tanning and melanin is inhibited. Large areas of hyper­pigmenta­tion seldom lighten uniformly with hydro­quinone. During treatment, patches of lightened skin may appear among darker areas. This can trigger additional emotional issues. Patients may be urged to seek non-irritating opaque cosme­tics with UV inhibitors.

Dark Side of Hydroquinone

The sun emits visible light along with invisible ultraviolet-B (UVB) and -A (UVA) radiation. Sunburn is caused by UVB radiation. (Think “B” for “burn.”) Skin tanning (melanin darkening) is caused by UVA radiation. Preventing sun damage through application of UVA sunscreens is fundamental. In fact, sunlight dramatically reduces the effects of hydroquinone.

As discussed thus far, complete hydroquinone skin lightening care includes deep cleansing, skin lightening, an anti-inflam­matory drug, UV protec­tion and possibly hypo­aller­genic cosmetics. A complete course of treatment can take 4 to 12 months. Discon­tinuing product use or providing a rest for skin may be recom­mended if results are not observed within an established period of time.

Complex subdermal chemical changes are triggered by hydro­quinone. Often it is combined with other ingre­dients to enhance penetra­tion, reduce sun damage, or minimize irrita­tion. In light of potential complica­tions, it seems prudent to pursue hydro­quinone use only under the care of a qualified physi­cian or inquire about alterna­tive treat­ments such as exfolia­tion and dietary changes.

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Kevin Williams is a health advocate and writer of hundreds of articles for multiple websites, including: A Bit More Healthy, KevinMD, and Sue’s Nutrition Buzz.

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