Recently, my friend Jessica over @ Out in a Pout wanted to know the potential side effects of discontinuing use of hydroquinone. Now, Jessica’s a beauty expert herself, so her question really made me ponder just how much the public knows about hydroquinone. So I started avidly researching the topic. Turns out there is so much to know:
1.) Hydroquinone should be used in four-month cycles, alternating with kojic acid, azelaic acid, arbutin, and other lightening agents. (Especially if you have darker skin).
Hydroquinone works by inhibiting the enzyme tyrosinase, which is important in skin melanin (pigment) development. So for as long as you continue to use hydroquinone, you will inhibit tyrosinase, and hence pigment production.
Unfortunately, when you discontinue use of hydroquinone, your skin’s natural supply of tyrosinase will no longer be inhibited. Slowly but surely, your skin’s natural pigmentation will return.
If you’re thinking that you should never stop using hydroquinone, think again: In darker skinned patients, continued hydroquinone use has been associated with ochronosis, a darkening of the skin. It has been proposed this occurs because hydroquinone inhibits homogentisic acid oxidase within the skin, which in turn causes the dark-colored homogentisic acid to build-up within the skin with continued use. Interestingly enough, this phenomenon has only been documented in darker-skinned patients.
Still, to be on the safe side, most dermatologists recommend using hydroquinone in four-month cycles, alternated in the off months with other milder tyrosinase inhibitors, such as azelaic acid, kojic acid, and arbutin. I personally recommend Cape Fear Naturals Kojic Acid Cream Skin Brightener ($11.95, Amazon.com) with 4% kojic acid, the highest concentration available on the U.S. market without a prescription. To be frank, the packaging could use a makeover and the retinol is rendered virtually worthless with full air exposure in the open-top jar container, but the truth of the matter is, no product on the market contains more skin-lightening kojic acid for a lower price. It also works great when alternated for four months with hydroquinone, as mentioned above.
2.) Do NOT use any other products containing benzoyl peroxide while you are using products containing hydroquinone.
Use of hydroquinone with any products containing benzoyl peroxide, hydrogen peroxide, or other peroxides may cause temporary staining of the skin (Drugs.com). This staining is temporary and can typically be removed with soap and water washing, but it’s best to avoid benzoyl peroxide-based acne treatments and oxygen-infusing skin care treatments, which typically contain hydrogen peroxide.
3.) Do NOT use any products containing resorcinol while you are using products containing hydroquinone.
Remember that skin darkening I was talking about earlier (ochronosis)? Unfortunately, ochronosis occurrence in persons with darker skins is a well-documented occurrence with combined use of resorcinol and hydroquinone. Hundreds of ochronosis cases have been documented from using resorcinol/hydroquinone combination treatments in South Africa before 1984 (Journal of Dermatological Treatment, 1997).
So I definitely would not recommend using hydroquinone with any of the new resorcinol skin lightening treatments, including Clarins Vital Light Serum and philosophy® Miracle Worker® Dark Spot Corrector (shown above). While I love these products on their own, I would not recommend combining them with any treatments containing hydroquinone, even for those with lighter skin types.
4.) Do NOT get hydroquinone anywhere near your eyes.
Despite popular belief that hydroquinone may cause cancer, hydroquinone’s most serious human health effect is pigmentation of the eye and permanent corneal damage (Journal of the European Academy of Dermatology and Venearology, 2006). While this only occurs when the eye is directly exposed to hydroquinone, it is still a risk factor. It is therefore vitally important to avoid the eye area in applying hydroquinone-based creams.
5.) Hydroquinone has NOT been directly linked to cancer in humans – only mice.
Some believe that hydroquinone may cause cancer. This is false. How this rumor arose stems from a study that demonstrated mice exposed to hydroquinone developed liver tumors. However, these results were reported in a misleading fashion, as dermatological experts explained in a 2006 review in the Journal of the American Academy of Dermatology:
Instead of being harmful to the skin, hydroquinone increased the number of benign (non-cancerous) liver tumors, reducing the proportion of cancerous liver tumors in the mouse, showing a protective effect of hydroquinone. (For you science buffs out there, there was an increase in hepatic adenomas and a decrease in hepatocellular carcinomas).
As for other studies associating mouse kidney tumors with hydroquinone use, it has been argued that these are not relevant to humans. As Dr. David J. Goldberg, a clinical professor of dermatology at the Mount Sinai School of Medicine states, “Over 100 scientific articles confirm hydroquinone is a safe topical for humans; no independent studies prove the opposite.”
Bottom Line
Of the skin-lightening and age spot-brightening agents out there, 4% hydroquinone is the most effective. Overall, it is considered to be safe, but it is important not to use hydroquinone in conjunction with any creams containing peroxides or resorcinol, to avoid the eye area completely, and to switch off with other agents every four months to lower the risk of ochronosis (skin darkening from the build-up of homogentisic acid). In addition, if you have darker skin, you may wish to speak to your dermatologist first, as ochronosis is much more common in those with darker skin tones.
I hope this guide helps you. Please, keep the great questions coming!
Other Posts You May Enjoy
Great post, thank you. I had heard that you should use hydroquinone in cycles, but I didn’t know any of the other stuff here. Perfect timing too – I just started using Ambi Fade cream after reading your post on it!
Hi!
I’m currently washing my face every other day with Neutrogena Clear Pore Cleanser/Face mask that has 3.5% benzoyl peroxide and using a Alpha Hydrox targeted skin lightener with 2% hydroquinone. Would this combination be detrimental to my skin, even if the benzoyl peroxide is going to be washed off?
Thanks!
Thank you for this informative article!
Great post. I was under the impression that hydoquinone was taken off the market awhile back. I used to use it and loved it when Serious Skin Care on HSN had it. I didn’t know any of these facts about it. Hopeful that I can stumble into some in the future.
What about using Kojic Acid and Vit C serum togehther in the morning, and Retin-A at night? I have been using Obagi forever, yr post is a great reminder that it is time to give it a break…thnx!
Also are there any light serums with Kojic Acid 4%? I love CE Ferulic, and want to add that on top but am looking for least unnecessary ingredients and lightest formulation possible…THNX again:-)
Nicki, you’re a wealth of knowledge- thanks so much for writing this! I knew if anyone could get down to brass tacks about an ingredient, it was you! I’ve done some research on it in the past, but there were still some issues nagging at me!
To help answer Kira’s question: there are several studies showing the benefits of using a therapy that combines Retinol and Hydroquinone. The prescription cream Tri-Luma is actually a combination of those ingredients with an added anti-inflammatory ingredient.
Since hyrdroquinone inhibits melanin production and the retinol encourages more “healthy” cell production, it would seem reasonable to assume that using the two together could reduce the recurrence of the pigment once the hydroquinone use is decreased or stopped. Indeed, most of the studies I found support the idea that combination therapy is indeed more effective.
I will add that most of what I saw in regards to hydroquinone treatment referred to at least an 8 week course of DAILY treatment. Retinol can be hard to use on a daily basis until your skin is acclimated to it, so I personally would only start a combination therapy after using retinol alone for some time until my skin was past the initial irritation.
Also, just a little tidbit on the subject of pigment returning when hydroquinone use is discontinued. It seems to be very important to employ a “maintenance regiment” after you achieve your desired lightening results. Alternating 4-month cycles like Nicki suggests, or tapered use of hydroquinone (rather than daily use, you’d apply 2-3 times weekly for a couple months, then just once a week for the next few) may be useful in keeping the pigment from popping back up over the long-term.
Finally, it might be helpful to know that I did see evidence on this subject said that even those people who do see relapses in their hyper-pigmentation still have an overall improvement, so the idea of the spot recurring shouldn’t stop people from seeking treatment.
Thanks again Nicki, you’re the best!