Hydroquinone is a skin-lightening agent used to treat pigmentation. It has been the gold standard for treating hyperpigmentation for more than 50 years. Clinically, it is used to treat areas of dyschromia such as in melasma, chloasma, solar lentigines, freckles and post-inflammatory hyperpigmentation. It can also help reduce the appearance of acne scars. Hydroquinone can be purchased over-the-counter in concentrations up to 2%. A prescription is required for concentrations higher than 2% and the highest dose available is 4%. Doses higher than 2% need to be administered carefully by a medical professional. Hydroquinone can be mixed into a cream or a serum and it is often best used as part of a combination with other medications such as retinoids and corticosteroids.
How does hydroquinone work?
Hydroquinone acts as a skin depigmentation agent by inhibiting the process of melanin synthesis. Hydroquinone stops the conversion of L-DOPA to melanin by inhibiting the enzyme tyrosinase. It also acts to increase the breakdown of melanosomes in melanocytes. Melanocytes are the melanin forming cells in the skin. Melanosomes are the structures within the melanocytes that are directly responsible for making melanin. Hydroquinone is thought to modify the formation of melanosomes and/or reduce their activity, thus reducing the amount of melanin produced.
Hydroquinone should always be used under the supervision of a doctor so as to prevent unwanted side effects. We generally recommend using a safe dose of hydroquinone once or twice per day for a period of 3 to 6 months. We will check in with you after 3 months to see if you have noticed any improvement with the hydroquinone. If you have not seen any results after 3months we will discontinue this medication. After 6 months of use, we will generally stop the medication for a period to decrease the risk of side effects. Following this, we may recommend a safe maintenance dose. We recommend applying hydroquinone only to the hyperpigmented areas of your skin as it will lighten normal skin as well. Avoid applying near the eyes and mouth. Apply hydroquinone to your skin first then wait a few minutes before applying sunscreen, moisturiser and/or makeup.
What are the side effects?
Hydroquinone cream is usually well tolerated. Some patients may experience minor skin irritation, which tends to be temporary. Symptoms may include mild itching, stinging and reddening of the skin. If these symptoms do not subside the treatment should be stopped. In some rare cases, you may experience severe burning, itching, crusting or swelling of the areas where hydroquinone has been applied. If this occurs, the treatment should be stopped immediately and medical advice should be sought urgently. This may indicate an allergic reaction. Prolonged use of hydroquinone can lead to a rare complication called ochronosis, which is a persistent blue-black pigmentation of the skin. For this reason, hydroquinone should only be used as directed by your doctor. This treatment should not be used in combination with any peroxide products as this can cause temporary dark staining of the skin. Hydroquinone should not be used in pregnancy or when breastfeeding.
When will I see results?
In most cases, you should see a change in your skin within about 4 weeks of treatment. Your skin should appear lighter and more even with less hyperpigmentation. In some cases, it may take longer to see the effect of hydroquinone however, if you do not see any results after three months it should be stopped. As hydroquinone works to decrease the amount of melanin being produced by your body, it is important to reduce harmful UV light exposure from the sun. Hydroquinone should be used in combination with anSPF30+ sunscreen or higher, and other sun protection such as hats and protective clothing should be worn.
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