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