Each time I do a post on  skin lightening and mention hydroquinone, I get a flurry of concerned emails warning  me against using it.  Often  they point  out that hydroquinone can cause cancer and was banned in Europe.  Yet  the usually  quick to pull the recall trigger FDA still permits hydroquinone to be sold here– both in over the counter  formulations and in prescription only preparations.    I was both confused and worried.  Digging into the literature and talking  to a few trusted experts, here is the current  take on hydroquinone.

Hydroquinone is considered the most effective skin lightenens currently available and is one of  the very few on that acts by preventing melanin formation. There are three problems associated with hydroquinone:

1)  Tthe British Cancer Journal published  a study that linked  very high doses of hydroquinine to cancers in mice.  A second similar study found similar results.  Subsequently, hydroquinone was banned in Europe ,Australia and parts of Asia and Africa.    In 2006, the FDA  issued a four month moratorium on hydroquinone to review the data, but then allowed it to be used for”severe melasma for a short period of time”.   Animal studies linking something to cancer is certainly a big, ugly, red flag, but to date there are no studies that  show  it affects people the same way.

There is also concern that hydroquinone is linked to increased risk of skin cancer, because it  makes the skin more vulnerable to UV rays.  For this reason its important to use an SPF50   when treating the skin with hydroquinone based products.

2) Hydroquinine is thought to cause a condition called  ochronosis  which provokes the appearance of dark blue/black pigment in the skin.  If you pick up almost any article on hydroquinone  you will read about this problem.  However current wisdom now believes that  this problem is actually due to  the illegal presence of mercury in hydroquinone preparations, a common practice overseas including products from  South Asia,  and Africa.  It was interesting that at a national dermatology meeting this summer, the speaker  pointed out that  most dermatologists  had never seen a case of  ochronosis from hydroquinone in this country.  She asked the audience of 500 dermatologists to raise their hand  if they had seen the problem in any patient.  Only 2 out of the 500  raised their hands and both  had seen these patients  outside of the US– one in Africa and the other in Jamacia.  Interesting.

3) Hydroquinone  has been known to cause irritation and redness  which in women of color can lead to increased  patches of irregular pigmentation.  I personally experienced  the mother of all  reactions when I did a patch test of popular skin lightening product when I was still in high school.  A small dab in the crook of my arm produced  a five inch patch of red, itchy skin.  However, I was able to use Triluma without any problems, and I wonder what else was in that  old time skin bleach.  Because of its itrritation potential, doctors  agree that  it should not  be used on skin that is already sunburned, dry, chapped or inflamed.

So to bottom line it, hydroquinone is strong stuff  and certainly has some baggage.  But its still the most effective skin lightening  we have in out tool kit.   It seems to work beautifully with other ingredients like vitamin C, retin A and alpha hydroxy acids.  You can use lower concertrations and get addtional benefits from complementary ingredients.  Always keep the concentration of hydroquinone as low as possible.  Over the counter preparations can have up to 2% while those available by prescriptions usually have around 4% hydroquinone.  And only  buy skin lightening products made in the US.  Mercury has been  banned  for decades  and this seems to be a  major source of problems in skin bleaching  preparations from other countries