Hydroquinone Cream (hydroquinone) is a highly effective skin lightening product, though its use does require some care and it can be controversial.

The medication is usually used to lighten patches of darkened skin, from freckles to age spots. While many hyperpigmentation issues are the result of age, there are some conditions which cause dark spots in younger patients:

• Birth control pills
• Hormone therapy
• Pregnancy
• Melasma
• Injury to skin
• Natural causes (such as freckles)

The medication works by inhibiting production of melanin, which is usually responsible for dark patches of skin. Note that melanin is also responsible for absorbing UV rays; skin should be protected from UV rays using protective clothing and SPF15+ sunscreen during treatment. Tanning beds should also be avoided.

Lightening Skin with Hydroquinone Cream

Hydroquinone Cream, of any strength, should first be applied to a small patch of hyperpigmented skin as a test. After 24 hours, if no severe side effects have developed, treatment may commence. Many creams contain sodium metabisulphite, which can produce severe allergic reactions in some individuals. Side effects to watch out for include:

• Burning
• Itching
• Swelling
• Blistering
• Crusting
• Severe redness

Some redness at the application site is normal.

If ready to proceed:

• Clean and dry affected skin.
• Apply a thin layer to the affected area.
• Repeat twice per day.
• Avoid getting the cream on normal skin.
• Wash hands after application.

Things to avoid include:

• Do not get the cream in mucous membranes. Rinse thoroughly with water if this does occur.
• Avoid other medicated skin products---particularly peroxide. Peroxide can cause temporary skin darkening.
• If applying other skin products---such as sunscreen or moisturizers---wait several moments for Hydroquinone Cream to dry before application.
• Do not use Hydroquinone Cream if pregnant or breastfeeding.

Results should be visible after about 1 month of regular treatment. In some cases it may take a few weeks longer. If there are no visible improvements after three months, consider alternative products.

Duration of treatment can be variable, depending on the severity of the darkened skin, the desired lightness, the effectiveness of Hydroquinone Cream, and other factors. In some cases treatment is reversible, meaning the dark patches will return after treatment ends; in other cases it is permanent. Assuming no serious side effects develop, treatment can be repeated if needed in the future.

Controversies

Hydroquinone Cream was once widely available without a prescription. Controversy came about primarily through three events:

• 1) South Africa banned the product after a series of serious side effects were noted from the cream. While it was soon discovered that the South African cream contained glucocorticoids, mercury, and other ingredients much more likely to be responsible for the side effects than Hydroquinone, the damage was done and it was largely made a prescription product in the EU as well as South Africa.
• 2) In the USA, though initially approved, several agencies raised concerns that use does produce carcinogenic and other tumor concerns, largely based on rat studies. While one can still purchase 2% Hydroquinone Cream over-the-counter in the USA, anything higher requires a prescription.
• 3) Is the discovery that Hydroquinone Cream can cause, in very rare cases, a condition called exogenous ochronosis. In this condition the skin darkens rather than lightens, often with a blue tinge. It can be very unsightly, and is very difficult to treat. It is unclear if Hydroquinone itself or other ingredients included with some creams are responsible.

Of the above, exogenous ochronosis is probably the greatest concern with Hydroquinone Cream. Though very rare, it can be very unsightly, and it appears it may be a legitimate concern. Sun exposure worsens it, and sun exposure is a concern anyway; use of sunblock and/or protective clothing is strongly recommended throughout treatment.

Conclusion

There is no doubt that Hydroquinone Cream is among the most---if not the most---effective skin lighteners currently available. Millions of people have used this product with no issues. Patients may want to check the inactive ingredients included with the cream for anything suspicious, especially if using generic, inexpensive products; many of the controversial aspects of Hydroquinone seem to arise from those rather than Hydroquinone itself.

On the other hand, it is possible that a small percentage of patients will develop tumors, cancer, or exogenous ochronosis from this product. Use should be weighed against these potential risks, and use of this product---like any medication---should be kept to a minimum, using the smallest effective amount for the shortest effective period of time.