How Effective Is Hydroquinone When Treating Dark Spots On Your Skin?

Whether you have unwanted freckles, age spots, acne scars, or melasma, you may be wondering whether hydroquinone can help treat your skin to reduce visible dark spots. How effective is hydroquinone really?

How does it work?

Hydroquinone does not physically bleach the skin; rather, it reduces the appearance of dark spots by decreasing the production of melanin, a biological polymer that contributes to hair and skin color. It accomplishes this by decreasing the production and encouraging the breakdown of melanocytes – cells that produce melanin at the base layer of the skin to protect skin from ultraviolet radiation damage.

How do you use hydroquinone? Are there any side effects?

Creams containing low amounts of hydroquinone used to be available over the counter (OTC), but due to OTC drug reforms contained in the CARES Act, those products were pulled from shelves as of September 23, 2020. Currently, hydroquinone products are prescription-only in the United States. They are typically topical creams or ointments.

Generally, hydroquinone creams are well tolerated when used correctly. Some people may experience minor skin irritation such as mild itching, stinging, or redness that should be temporary. If these symptoms do not subside, or you experience more severe symptoms such as severe burning, swelling, or crusting of skin, you should stop using hydroquinone.

You should also be careful about what other products you are using with hydroquinone, as combining peroxide products with it may result in temporary dark staining of the skin. Some creams may contain sodium metabisulphite which can cause allergic reactions like anaphylaxis in those who are allergic. Pregnant or breastfeeding women should not use hydroquinone.

How effective is hydroquinone?

Hydroquinone has been studied for its effectiveness in topically treating melasma for some time. A review of 113 studies shows that hydroquinone therapy – whether monotherapy, or within a combination cream – is among the most effective topical treatments available (McKesey). A study testing a hydroquinone monotherapy indicated an 85% satisfaction rate after a 12-week period, with 90% of participants reporting that they no longer made significant efforts to hide skin discoloration (Grimes). Another study comparing hydroquinone to kojic acid found hydroquinone not only produced better results, but also caused less irritation than kojic acid (Monteiro).

Hydroquinone’s lightening effects are generally visible after 4 weeks of treatment, though some conditions may require a longer treatment plan. If no visible changes occur after 3 months of treatment, you should stop using hydroquinone and consult with your dermatologist about alternative treatment options.

Hydroquinone treatments are designed to lighten dark spots to the desired tone so that you may discontinue use and maintain skin health with lifestyle changes, like avoiding tanning and using sunscreen and protective clothing when outdoors.

Using hydroquinone over too long a period of time can lead to ochronosis, a rare condition that causes blue-black pigmentation of the skin that is difficult to treat. It is unclear whether this directly results from hydroquinone use, or if it’s a reaction caused by hydroquinone interacting with other skincare and antimalarial treatments that also pose an ochronosis risk.

References

• Grimes P, Watson J. Treating epidermal melasma with a 4% hydroquinone skin care system plus tretinoin cream 0.025%. Cutis. 2013;91(1):47-54.
• McKesey, J., Tovar-Garza, A. & Pandya, A.G. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol 21, 173–225 (2020). https://doi.org/10.1007/s40257-019-00488-w
• Monteiro RC, Kishore BN, Bhat RM, Sukumar D, Martis J, Ganesh HK. A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma. Indian J Dermatol. 2013;58(2):157. doi:10.4103/0019-5154.108070

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.