The Definitive Guide to Hydroquinone

The growing field of hyperpigmentation skincare offers an array of products, all of which claim to deliver remarkable results. Amongst these, Hydroquinone stands out. It is distinguished by its robust pigment suppressing properties and years of clinical research. This guide aims to provide a detailed guide to Hydroquinone for skin including how it works, benefits, side effects and tips for properly adding it into your skincare regime. We also discuss its safety, side effects and the controversies surrounding it.

What is Hydroquinone?

Hydroquinone is a topical medication that is used as a skin lightening agent to fade hyperpigmentation and melasma. It works by reducing the production and increasing the breakdown of melanin pigments in the skin. This helps lighten the skin areas that are darker (hyperpigmented). If used correctly, it evens out skin tone without bleaching the normal skin. Hydroquinone is available in various strengths but most commonly 2% (over-the-counter) and 4% (prescription strength) are used. In the UK, Hydroquinone is a prescription only medicine at any strength

The Science Behind Hydroquinone for Skin Uses

Hydroquinone works by inhibiting the enzyme tyrosinase, which is crucial for melanin production. This inhibition reduces the production of melanin pigment, leading to lighter skin over time. It’s often only used over a few weeks or months. This allows for gradual and consistent lightening of hyperpigmented areas.

What is Hydroquinone Used For?

Hydroquinone’s journey in skincare started in the early 20th century, when its ability to lighten skin was first recognized. The FDA approved it as an over-the-counter (OTC) drug in 1982 to treat skin conditions like melasma, age spots, and acne scars.

Hydroquinone is mainly used to treat hyperpigmentation and melasma. It is able to effectively lighten dark patches and spots on the skin caused by pregnancy, birth control pills, hormone medicine, or injury to the skin. Moreover, it can help to reduce age spots and freckles, thus making it a potent ingredient in any skincare routine. In the case of acne scars, it reduces the visibility of post acne dark marks by lightening hyperpigmented skin.

Hydroquinone Cream, Gel, Emulsion, Lotion or Solution: What’s the Difference?

Hydroquinone is available in several preparations. These are available as creams, gels, emulsions, lotions, or solutions. Whilst the active component, remains the same, the difference lies in the formulation and texture of the product. Most people do well with the cream but your doctor will prescribe the best preparation for your skin type and what you personally prefer.

  1. Cream: Hydroquinone creams are thick, heavy, and generally more moisturising. They are particularly good for individuals with dry or mature skin types. They’re also less irritating so better accepted by people with sensitive skin. Ceams can provide a strong barrier, which can aid in the penetration and absorption of the active ingredient into the skin.
  2. Gel: Hydroquinone gels are usually clear, lightweight, and less moisturising than creams or lotions. They absorb quickly and don’t leave any residue behind. They’re a good option for very oily or acne prone skin types because they’re less likely to clog pores.
  3. Emulsion: Hydroquinone emulsions contain a mixture of oil and water. They are lightweight and can be good for most skin types. Emulsions are generally well absorbed, provide some level of hydration and can be used under makeup without causing pilling or heavy feeling on the skin.
  4. Lotion: Hydroquinone lotions are similar to creams but are generally lighter and less greasy. They are well suited for normal to slightly dry or slightly oily skin types. Like creams, lotions form a barrier that aids in its absorption.
  5. Solution: A solution normally refers to a liquid that contains a dissolved substance, in this case, Hydroquinone. Solutions can be used for all skin types and are particularly useful if you want a fast absorbing, lightweight product.

Generic Hydroquinone vs Branded Hydroquinone

Generic Hydroquinone is highly effective. However brand name versions such as Obagi Nu-Derm Clear and Blender or in kits such as Obagi-C and Nu Derm are generally more popular. This is due to their advanced formulas that may enhance stability and skin penetration. Hydroquinone is also available in compounded treatments which are personalised to individual patients to treat skin ageing and hyperpigmentation. These offer the ability to customise the preparation completely around a patient’s needs. Overall, the active ingredient are the same as in compounded, generic and branded formulas.

Compatible Skincare Products

Certain skincare products can boost the effects of Hydroquinone or enhance its ability to reduce the appearance of hyperpigmentation, melasma and acne scars.

Hydroquinone and Retin-A (Tretinoin)

Retin-A is a form of Vitamin A that boosts skin cell turnover, reduces inflammation, fades hyperpigmentation and unclogs pores. When used with Hydroquinone, it can speed up the process of fading hyperpigmentation. These two ingredients can be found together in compound preparations or used as separate products for more control.

Hydroquinone and Vitamin C

Vitamin C is an antioxidant that neutralises free radicals and regenerates the skin. Its skin brightening effects pair well with Hydroquinone to create a more even skin tone.

Hydroquinone and Alpha Hydroxy Acids (AHAs)

AHAs, like glycolic acid and lactic acid, exfoliate the skin and boost cell turnover. When used with Hydroquinone, these acids can enhance the skin lightening and acne scar fading effect of Hydroquinone.

When Will I Start Seeing Results on my Skin from Using Hydroquinone?

Results normally start to appear after 4 weeks of regular use. However, in some cases, it might take up to several months to observe noticeable improvements. It’s crucial to use Hydroquinone as directed by your healthcare provider.

How to Use Hydroquinone

Th way you use Hydroquinone will depend on the directions given to you by your doctor. These will be tailored to your skin concerns and goals. Your doctor will also adapt your protocol as time goes by according to how your skin responds to and tolerates the treatment. This will include how much product to use, frequency and where in your skincare routine it should go. The latter depends on what other active products you are using in your skincare routine.

It’s also important to avoid unnecessary sun exposure when using Hydroquinone, as this can reverse its skin lightening effects and lead to further skin damage. Using a broad-spectrum sunscreen daily is a must.

Side Effects & Risks of Hydroquinone

Although Hydroquinone is generally safe for most people when used correctly, it does come with some potential side effects. These include skin irritation, redness and dryness. These are usually mild and subside as your skin adjusts to the product.

In rare cases, it can cause a condition called ochronosis. This presents as skin darkening or blue-black discolouration and can occur with prolonged use of high strength Hydroquinone. Therefore, it is best not to use it for more than five to six months at a time.

Another important risk is that of rebound hyperpigmentation. This is the darkening of the skin after stopping the use of skin lightening products like Hydroquinone or exposure to sun light whilst using it. This occurs because the skin may increase the production of melanin once the blocking effect of Hydroquinone stops, leading to darker skin than before treatment. To reduce this risk, doctors often recommend “cycling” Hydroquinone. This means using it for a limited period followed by a break.

Safety Concerns

Although there were concerns about Hydroquinone’s safety due to its ban in some countries (Japan, Australia, Brazil, South Africa, Nigeria, Ghana and Kenya), the FDA has reaffirmed its status as a safe and effective treatment for skin discolouration. In the UK and EU it is available as a prescription only medicine. It’s worth noting that the bans are largely due to issues with misuse, such as using overly high strengths, using it over large areas of the body or using it for very long periods, rather than Hydroquinone itself being unsafe.

Who Should Not Use Hydroquinone

While Hydroquinone has proved highly effective for treating hyperpigmentation, it’s not for everyone. This is why it should only be used under the care of a doctor. Pregnant or breast feeding women should avoid it as the effects on the foetus or infants are not clearly understood. It is also not safe for people with liver disease or kidney problems since Hydroquinone is broken down in the liver and removed via the kidneys. Additionally, those with sensitive skin or a history of allergic reactions should use it with caution, as Hydroquinone can sometimes cause skin irritation or contact dermatitis.

In terms of drug interactions, Hydroquinone can react badly with certain products including peroxides (found in hair products and some acne treatments), resorcinol, phenol, and salicylic acid. Using Hydroquinone with these products may cause temporary staining of the skin.

Controversies Surrounding Hydroquinone

Hydroquinone has been a subject of controversy due to its potential side effects and health risks. While it’s widely used in many countries as an effective skin lightening agent, it’s also been banned or restricted in others due to concerns about its safety. These are the main health and social controversies surrounding Hydroquinone:

Ochronosis

Prolonged use of hydroquinone, especially in high strength, can lead to a skin condition called ochronosis. This is a bluish-black discolouration of the skin. This is a rare side effect and usually only occurs with long-term use of high concentration hydroquinone (usually 4% and above).

Cancer Risk

Animal studies have raised concerns about the potential cancer causing potential of hydroquinone. However, it’s important to note that these studies usually involve doses and exposure levels far beyond what a human would experience when using hydroquinone on the skin and appropriately. To date, there’s no conclusive evidence linking topical hydroquinone use to cancer in humans.

Skin Irritation

Hydroquinone can cause skin irritation, especially in individuals with sensitive skin or when used in high strengths. This can lead to redness, peeling, dryness, and burning feeling.

Banned in Certain Countries

Due to the above concerns, some countries, including those in the European Union, have banned hydroquinone’s use in over-the-counter (OTC) products. In the United States, it’s available in OTC products in concentrations up to 2%, while higher strengths (up to 4%) are available with a prescription.

Ethical and Social Issues

Apart from health concerns, the use of hydroquinone for skin lightening also raises ethical and social issues. It is also associated with colourism. This is a prejudice or discrimination against individuals with a dark skin tone, usually, but not always, amongst individuals from the same racial or ethnic group. The use of skin bleaching products can perpetuate harmful beauty standards and racial biases.

These controversies highlight the need for further research into the safe use of hydroquinone and the importance of considering the social and ethical implications of its use. It’s crucial for individuals considering hydroquinone to have a comprehensive discussion with a doctor or other healthcare provider to fully understand its potential risks and benefits.

Hydroquinone has been a key tool in dermatology for its powerful skin lightening effects. It’s an effective way to treat various types of hyperpigmentation and achieve a more even skin tone. As with any potent skincare product, it’s essential to use Hydroquinone responsibly, follow directions, and consult with a doctor or healthcare professional to ensure it’s right for your skin. When used correctly, Hydroquinone can be a game changer in your skincare routine, providing you with a brighter and more even complexion.

Where to Get Hydroquinone in the UK

In the UK, Hydroquinone is a prescription-only medication. Traditionally, you could get it from a dermatologist or an aesthetic doctor in a bricks-and-mortar clinic. However, it is now possible to get Hydroquinone online in the UK from a number of online prescription skincare services if they assess it is safe and beneficial for you.

How We Can Help You 

At City Skin Clinic we provide personalised skincare treatments for a variety if skin conditions through our online skin clinic. Our doctors design custom made treatments to suit each patient’s needs which include ingredients like Hydroquinone where appropriate. Your treatment is delivered straight to your home and your doctor will continue you to provide you with ongoing advice and aftercare virtually. This way we ensure that you get the most out of your treatment. Book your online consultation today to start your skincare journey.

Frequently asked questions

Yes, hydroquinone is generally safe for use as directed by a healthcare provider. However, it is crucial to follow their instructions, as misuse can lead to skin irritation, discolouration or more serious side-effects.

This depends on the extent of your hyperpigmentation and the formulation used. For discrete areas of hyperpigmentation, hydroquinone should only be applied to areas of discolouration and not the entire face. Your doctor will advise whether to use it locally or over a wider area.

Hydroquinone should not be used continuously for extended periods (no more than 24 weeks at a time is recommended). Your healthcare provider will recommend the duration of usage, typically between a few weeks to several months. They may add a break period to prevent side effects.

If you experience any side effects such as redness, dryness, or excessive skin irritation, discontinue use and consult your healthcare provider immediately.

Sources

Authored by:

Dr Amel Ibrahim
Aesthetic Doctor & Medical Director
BSC (HONS) MBBS MRCS PHD
Founder City Skin Clinic
Member of the Royal College of Surgeons of England
Associate Member of British Association of Body Sculpting GMC Registered - 7049611

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