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In one of my favorite episodes of Sex and the City, Miranda talks about her “secret single behavior,” where she likes to go and clip her toenails while watching bad TV.
Skin bleaching is a little like that: It’s something that many people do, but refuse to share with others. In fact, 77% of women in Nigeria admitting to using skin bleaching creams (World Health Organization), and 258 tons of skin bleaching creams were sold to women in India in 2012 (Bloomberg Business Week). And its popularity is only growing stateside, with estimates on skin bleaching cream sales estimated to grow to $19.8 billion in the United States alone by 2018.
The real secret behind skin bleaching creams is hydroquinone, a controversial ingredient. Here, I’ll talk about the benefits, the risks, and who should and who should not be using it in their skin regimen.
My Favorite: Clinicians Complex 6% Skin Bleaching Cream
My favorite skin bleaching cream is Clinicians Complex 6% Skin Bleaching Cream, a formulation that contains hydroquinone, kojic acid, and bearberry extract. I estimate from the ingredients list it contains about 2% hydroquinone, 2% kojic acid, and 2% bearberry extract — which is the highest concentration of hydroquinone currently available in the U.S. over-the-counter. Its efficacy has been well-established over time, including in a 2003 study in The International Journal of Dermatology, where it was found to reduce signs of hyperpigmentation associated with melasma by a whopping 76.9%, beating another skin whitening complex at 66.7%.
I’m a fan of hydroquinone, so long as you: a.) do not have dark skin (darker skin tones run the risk of ochronosis); b.) apply in four-month on, four-month off cycles; and c.) do not combine with benzoyl peroxide or resorcinol (see below). Overall, however, I like it and I think it is the major secret behind this cream.
Ingredients: Deionized Water, Mineral Oil, Glyceryl Stearate, Sodium Lauryl Sulfate, Poloxamer 188, Alcohol, Passionflower Fruit Extract, Pineapple Fruit Extract, Grape Fruit Extract, Hydroquinone USP, Kojic Acid Dipalmitate, Cetyl Alcohol, Emulsifying Wax NF, Bearberry Extract, Glycerine, Magnesium Ascorbyl Phosphate, Stearyl Alcohol, Octyl Palmitate, d-Alpha Tocopheryl Acetate USP, Cetyl Esters, PEG-40 Stearate, Hydroxyethylcellulose, Propylene Glycol USP, Sodium Sulfite, Sodium Metabisulfite, Diazolidinyl Urea , Methylparaben, Propylparaben.
How Does Hydroquinone Work?
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.
Is Hydroquinone Risky?
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 everyone uses hydroquinone in four-month cycles, alternated in the off months with other milder tyrosinase inhibitors, such as azelaic acid, kojic acid, and arbutin.
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.
Some believe that hydroquinone may cause cancer. This is false. 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 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.”
Do NOT Use Hydroquinone Together with Benzoyl Peroxide or Resorcinol!
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.
In addition, you also want to avoid using resorcinol with hydroquinone. Ochronosis occurrence in persons with darker skin 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).
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!