5 Little Known-Facts Every Hydroquinone User Needs to Know – Immediately!

Skin Care
Skin Bleaching

Cape Fear Naturals - Kojic Acid Cream - Natural Skin Lightener, Even Skin Tones - 2oz jar, 4% Kojic AcidRecently, my friend Jessica over at 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 4-MONTH CYCLES, alternating with kojic acid, azelaic acid, arbutin, and other lightening agents (especially if you have darker skin)

how hydroquinone works

Hydroquinone works by inhibiting the enzyme tyrosinase, which is important for the development of skin melanin (pigment) . 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.

ochronosis

If you’re thinking that you should never stop using hydroquinone, consider this: in darker-skinned patients, continued hydroquinone-use has been associated with ochronosis, a darkening of the skin. It has been proposed that this occurs because hydroquinone inhibits an enzyme called homogentisic acid oxidase within the skin, which in turn causes the dark-colored homogentisic acid to build-up within the skin with prolonged use. Interestingly enough, this phenomenon has only been documented in darker-skinned patients.

To be on the safe side, most dermatologists recommend using hydroquinone in four-month cycles, alternated in the off-months with 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 in 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 well when alternated for four months with hydroquinone, as mentioned above.

[RELATED: Does Ambi Fade Cream Really Work?]

2.) Do NOT use any other products containing benzoyl peroxide while you are using products containing hydroquinone.

Never combine Benzoyl Peroxide and Hydroquinone

Use of hydroquinone with any products containing peroxides like hydrogen peroxide or benzoyl peroxide may cause a temporary staining of the skin (Drugs.com). This staining can typically be removed with soap and water, but it’s still best to avoid benzoyl peroxide-based acne treatments and oxygen-infusing skin care treatments (which typically contain hydrogen peroxide) while using hydroquinone.

[RELATED: What are the Best Skin Brightening Agents in Skin Care?]

3.) Do NOT use any products containing resorcinol while you are using products containing hydroquinone.

Philosophy Miracle Worker(R) Dark Spot Corrector

Remember that skin darkening I was talking about earlier (ochronosis)? Unfortunately, ochronosis  in persons with darker skin is a well-documented phenomenon for those who combine 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).

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 each of these products on their own, I would not recommend combining them with any treatments containing hydroquinone, even for those with lighter complexions.

[RELATED: Clarins Vital Light Serum Review]

4.) Do NOT get hydroquinone anywhere near your eyes.

hydr

 

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). While this only occurs when the eye is directly exposed to hydroquinone, it is still a risk factor.  Therefore, it is vitally important to avoid the eye area when applying hydroquinone-containing creams.

[RELATED: Are Essential Oils Dangerous? The Answer Might Surprise You!]

5.) Hydroquinone has NOT been directly linked to cancer in humans — only mice.

hydroquinone

 

Some erroneously believe that hydroquinone may cause cancer.  This rumor arose 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 mice, thus suggesting that hydroquinone may exhibit protective effects. (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.

Some argue that hydroquinone is banned in the European Union, but I would also argue that hydroquinone is used ubiquitously in Japan, South Korea, and many other Asian countries — and the cancer rates are far lower in most Asian countries! Of course, correlation does not imply causation, and I am not implying that hydroquinone prevents cancer. However, I am suggesting that hydroquinone is likely not a cancer-causing agent, or cancer would be far more prevalent in Asian countries than in the ultra-cautious EU.

[RELATED: Lumixyl: The New Hydroquinone?]

Bottom Line

Safe Hydroquinone

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 alternate with other agents every four months so as 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 before using a hydroquinone-containing treatment,  as ochronosis is much more common in those with darker complexions.

I hope this guide helps you. Please, keep the great questions coming!

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  • Jenny-April

    Brilliant article. Very informative

  • john

    Is it okay to apply a vitaminc serum and then a hydroquinone serum afterwards?

  • olasupo mariam omotayo

    use hydroquinone 3 to 4 cycle pls explain better I don’t understand I need to use something that will not harm my skin, my friends have been complaining that am getting darker

  • Precious

    There cream i use have there following ingredients :. aqua, glyceryl monosterate, cetosteryl alcohol, stearic acid, glycerine, isopropyl myristate, sls, hydroquinone,( max2%), perfume, sodium metabisulphite, citric acid, ascorbic acid, EDTA disodium, sodium vitae,,methylparaben, p_chloro_m_cresol, sodium hydroxide, OMC, vitae in E. The product name is call top claire plus and indeed it makes my skin beautiful. Please looking on this combination of ingredients, is it good for my skin or i discontinuou

  • Indi

    Hello, When you say 4 month cycle do you mean you can use it as much as you want for a month then take a 3 month break before reintroducing it? Thanks!

  • joy

    pls I have been using a cream that contain hydroquinone but never know any thing concerning it and presently I have discolouration on my face. pls what can I do?

  • Joan

    Hi, does hydroquinone go off at all? What is the safe timeframe to use a hydroquinone within? Thanks

  • NIKKI

    hello mam..i have acne marks on my face..it looks like brown spots..if i apply hydroquinone on this marks will it help ? am i suppose to apply the cream all over my face or only on these marks besides if i stop using the cream after i acheived my result will those marks come back? i am a fair person i just need treatment for acne marks…

  • chioma

    Please I need your advice urgently as am left in a very bad complexion ever since I stopped using my cream which contains 2% of HQ because of the fear of having skin cancers as it’s being rumoured here in my country Nigeria, I want to know if I can continue using that cream or I should combine an oil that contains vitamin c with a moisturising lotion cause I really need to brighten up….thanks

  • khanyi

    hi nick ,

    thank u very much for the information, I have got a two toned skin on my face, especially my forehead is darker than the entire sections of face .I have been struggling to get rid of that ,I once purchased silka papaya soap and it seems to work but slowly , what would you recommend for something that will give me my true colour ?

    • Nicki Zevola

      I would recommend vitamin CE serum in the AM, sunscreen in the AM.

      For the PM, hydroquinone if your skin can tolerate it, alternated in cycles with kojic acid. Then retinoids. If not tolerated, then use something like peptides, such as Lumixyl.

      hope this helps!

  • Nadia

    Hi,I am 37 years old and i need ur advice desperately.I am using a cream known as golden pearl since six years ,which’ve some amounts of HQ with percentage not mentioned.it has shown great results on my skin uptill now and I’ve a fair cmplexion and beautiful skin with little bit of freckles on my cheeks which are visible since two years while I’ve been using a sun block with spf 45 daily.what shoud I do,should I discontinue using it now for my ftutre good skin or not,kojic acid creams’ve not very good results as this one.

    • Nicki Zevola

      It doesn’t sound like you are having symptoms of ochronosis or any negative side effects from HQ, so I would not necessarily discontinue it. As I said above, I do recommend cycling off HQ for 3-4 months at a time, and using KA instead, and then cycling back. Hope this helps.

  • aleshaa

    hi there i have just started using KOJIC ACID & GLUTATHIONE DUAL WHITENING/BLEACHING SOAP in the moring leaving on my face 4 abt 30 seconds and washing it of then after about 10-15 mins i use my diy vitamin c 5% i wanted 2 ask can i use these both products together? i mean is that ok to do so? thx

    • Nicki Zevola

      @aleshaa – I have never heard of anyone having issues with using kojic acid or glutathione in combination with a vitamin C mask, especially one at such a low concentration as 5% vitamin C. I imagine that you will be totally fine.

  • Cecilia

    Hexylresorcinol is the same thing that resorcinol?

    Can be a product with hexylresorcinol used in the daily routine while hydroquinone is used at night? Or they cant be used together anyway?

    • Nicki Zevola

      @Cecilia — Hexylresorcinol is resorcinol attached to a hydrocarbon group. Their active chemical properties are the same. I never use hexylresorcinol with hydroquinone.

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  • honeyrose

    i used hydroquinone 2% because i’m dark complexioned and it gave me good results,,,and i use 30% spf ..please tel me if i discontinue should repigmentation occurs..even if i don’t go directly to sun rays and if i use continually hydroquinone what will happens..please reply me dear..

    • Nicki Zevola

      @honeyrose – If discoloration occurs where you have applied hydroquinone, definitely discontinue use and consult with a dermatologist. It’s funny, I have talked to many dermatologists and skin scientists, and about half are in favor of HQ and about half are not. I personally think it is safe, but I also would not want to play the odds and be one of the 0.1% or so who get discoloration.

      • Monica

        Hi Nicki,

        Your article was so helpful thank you! I was wondering how specific you have to be when applying hydroquinone because I have a couple big spots than a bunch of little spots. What happens if I get it on areas that don’t need lightening? Ps. Sorry to reply to this thread but I can’t find the prompt where I can start a new comment. Thank you!!

  • Missy

    Isn’t arbutin a precurser to hydroquinone thus is also deemed as unsafe?

    • Nicki Zevola

      @Missy – Arbutin is a precursor to HQ, but so little of it gets transformed into HQ within the skin that it is generally regarded as safe. There’s a lot of fearmongering by natural product companies to get customers and political activist groups to get support (i.e., your email address), but I think the scientific evidence shows arbutin is fine.

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  • Braden Breckenridge

    What sort of cleanser should I use? Currently I am using a 2% hydroquinone cream in conjunction with cleansing my face with Proactive twice a day…. Proactive’s main active ingredient is benzoyl peroxide!! So naturally I jumped when I read your article…… Are there any certain cleansers you recommend that would be a better alternative? I certainly don’t want to harm my skin.
    Much thanks,
    Braden Breckenridge

    • Nicki Zevola

      @Braden – I don’t recommend one cleanser over another for use in conjunction with hydroquinone. For cleansers, I generally recommend those based on someone’s skin type and concerns. A few favorites of mine are Eve Lom Skin Cleanser for normal to dry skin, AminoGenesis Really Really Clean for normal skin, and Murad Facial Wash for Acne with salicylic acid for normal to oily/acne-prone skin.

  • Heather Jezorek

    Being a metabolite of benzene, hydroquinone has potential mutagenic properties. This is a good article, but fails to mention two important findings about the potential of hydroquinone to act as a carcinogen.
    1) The Occupational Safety and Health Administration (OSHA) in the United States claimed “hydroquinone is mutagenic and has cancer-causing potential.”
    2) In 1994, the Journal of the American College of Toxicology (now known as the International Journal of Toxicology) published “The Addendum to the Final Report on the Safety Assessment of Hydroquinone.” Its conclusion stated 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%.”
    Yes, the FDA still considers it safe, although it has said it would review the safety and so far has not.

    • Nicki Zevola

      @Heather — Not so fast.

      At least a portion, if not all, of the chromosomal effects are caused by interference by hydroquinone or its metabolites with chromosomal segregation, probably due to interaction with mitotic spindle proteins. However, the dose routes used to demonstrate these effects in almost all of the studies in vivo were intraperitoneal or subcutaneous injection, which were considered inappropriate. (source: http://www.ncbi.nlm.nih.gov/pubmed/18027166)

      Many of these studies reporting hydroquinone is mutagenic are conducted using high concentrations of hydroquinone that are injected into animal subjects at extremely high, unrealistic doses. Even orange extract could kill a rat or induce abnormalities if injected into the bloodstream at some of those doses!

  • meistershave

    Just purchased Cape Fear Naturals Kojic Acid Cream, which I use for general skin maintenance. Product seems to work and I have no great complaint; just a question: the cream has some sort of “grit” commingled in it. It looks as if one or some of the ingredients crystallized — an old batch, perhaps? The little crystals can break, but they don’t melt readily or absorb into the skin. Just wondering if anyone has had a similar experience with the product.

  • Juanita

    Could the combination of Kojic Acid and Licorice Extract exfoliate callous skin from the heel of the foot?

    • Juanita, have you ever tried a product called BABY FOOT? It is amazing! It is like a chemical peel for your foot. You put these booties on that have product I them and keep them on for an hour. You take them off and wash your feet. 5 days later, your feet start peeling like a snake, but when it’s over, your feet and heels, are like a baby’s foot!

  • Liz

    I hope you are still monitoring comments here as I have had trouble finding answers on life after hydroquinone. I have used Obagi-C for about 6 months to treat sun related melasma. I have had great results and am ready to move on. I took a couple week break halfway through and my face went crazy. I have very combination skin and frankly it’s been in the best shape of years using the obagi-c for dry/combination skin. I would like to try something without lighteners, but cannot find good suggestions of what to use to keep my skin from getting out of whack–is there anything that is a good system or product post hydroquinone without lighteners? Know that I also plan to try having a baby soon so want something safe for pregnancy as well. Thank you – I appreciate this post as there is very little information out there.

  • kandyce

    Topical products inhibit and lighten, maintenance is necessary, but what would actually remove hyperpigmentation/age spots on the face and decolletage more Permanently? After lighteners, microdermabrasion and chemical peels, step up’s would be IPL, Allumera plus IPL, then beyond that it’s other laser treatments like non-ablative fractional or ablative fractional lasers, yes? And then topical products for some maintenance. Any suggestions for more permanent dark spot removal?

  • Tourniquet

    I was fair in my childhood,due to playing a lot in the sun.i started tanning..LaTEr in my 9th standard i started using apricot scrub and my face started worsening..then i used a cloth washing scrubber harshly on my face.i got my forehead ,both side of my face darkened with a dry rough skin over those areas…i tried a lot of homemade treatments and all.itz been 5 years but my facial colour hasen’t regained.should i use hydroq,tetro an momentasone as told above..plz help.im just 20….proper guidance plz..i dun wanna worsen things up

    • Tourniquet, as a medical aesthetician, I would never recommend using a scrub with apricots, or nuts or any thing that abrasive on the skin. One of the reasons why is those little particles can actually scratch your skin, leaving little tears that the body recognizes as damage. It then sends melanin to the area and can cause more hyper pigmentation. I would recommend seeing a good aesthetician who can perhaps give you a low grade facial peel, and products that contain hydroquinone and retinal. Please treat your skin gently!

  • Tourniquet

    I have darkened my face due to harsh scrubbing and tanning…should i use hydroquinone tetrotin momentasone furoate as adviced by a derm.i showd hm my face and he wrote facial hyperpigmentation

  • @Fdarling – Wow, so glad to hear you have benefited from the site. Please keep it posted on how things work out with Nadinola!

  • Fdarling

    I am not sure if i have ochronosis on both of my cheeks but i know they are sun induced while using products to get rid of my melasma patch. It worsened. I recently purchased “Dr Lewinn Skin tone perfecting serum” while reading great reviews on MakeUpAlley , as well as another product called Nadinola which contains 3%HQ. The past 3 nights i would use the serum wait for it to dry then apply nadinola over top that! 3 nights is all it took to darken. I came across this post today. I googled the ingredients to Dr.Lewinn’s serum low & behold…resorcinol…O…EM….GEE! Thank God you saved me, you are truelly a life saver! I have eradicated Dr.Lewinn’s serum I am stearing clear of resorcinol for now. I will try Nadinola on its own on those spots and monitor it closely. Thanks for saving me! Pray for me that this works!

  • 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!

  • Kira

    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 Zevola

      Hi @Kira – I am unaware of any serums in the US market that currently contain and state they include 4% kojic acid. I do like the idea of kojic acid and vitamin C in the morning and Retin-A at night, however.

  • 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.

  • Thank you for this informative article!

  • ABC

    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!

    • Nicki Zevola

      It should be fine, so long as the BP is fully rinsed off. Hope this helps!

  • B

    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!

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