Reader Question: I started developing dark knuckles after moving to New Zealand from India in 2012. My hands feel cold throughout the year and I use gloves most of the time. My hands have started turning darker since last 3 years as well. Can you please suggest if I can use Ambi Fade Cream to cure this skin problem?
In short, yes. Ambi Fade Cream will help with dark knuckles. I would recommend a few things, though.
First, it is imperative that you first test the cream to ensure you don’t get ochronosis (reflective skin darkening) after using hydroquinone. A small percentage of darker-skinned folks get ochronosis when using hydroquinone, so you want to test on a small patch of skin (I would suggest the knuckle on your pinky finger) first.
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. However, it should be noted that it is typically less than 1% of patients.
Secondly, you want to allow your skin an environment to heal. Treat your hands delicately: Never let them go dry. That means no washing with very hot water, no excessive rubbing in the towel, and always, always moisturize. Be careful when handling rough objects like sandpaper or when doing activities like boxing, which impact the knuckles.
And if you are also treating acne, be careful not to get any benzoyl peroxide on your hands! 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.
Lastly, I’m a big fan of alternating hydroquinone in 3-4 month cycles with other agents. Keep in mind that 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. I don’t like to do this along the same pathway for more than 3-4 months at a time. Therefore, if you use Ambi Fade Cream or another 2-4% hydroquinone treatment for 3-4 months and still want further fading, I recommend switching to a different cream with kojic acid and/or arbutin.
Be careful that you only use hydroquinone on your knuckles, and don’t combine it with treatments containing resorcinol. Hundreds of ochronosis cases have been documented from using resorcinol/hydroquinone combination treatments in South Africa (Journal of Dermatological Treatment). Keep it to Ambi Fade Cream alone!
And, yes, I know hydroquinone is somewhat controversial online, but I have reviewed a lot of the literature and spoken to many experts about it, and I still feel comfortable using and recommending it. 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.”
Hope this helps!