Hydroquinone In Skincare: What Is It And Why Is It Used?

If you are researching skincare solutions for melasma or other hyperpigmentation conditions, you may have come across hydroquinone as a popular treatment option. Keep reading to learn what it is, how it’s commonly used, and whether hydroquinone in skincare is right for you.

What is hydroquinone and how does it work?

Hydroquinone is a topical skincare agent that lightens hyperpigmentation – dark spots on skin caused by higher concentrations of melanin. Hydroquinone does this by helping to reduce melanocytes, which produce melanin to protect skin from ultraviolet radiation damage. It works both to help break down existing melanocytes as well as prevent new melanocytes from forming.

Examples of conditions for which hydroquinone is a common treatment include:

• Freckles
• Melasma
• Post-inflammatory hyperpigmentation (occurs after injury to the skin, like from acne)
• Lentigines
• Pseudofolliculitis barbae (inflamed hair follicles of the beard)
• Poikiloderma of Civatte (pigmented skin disorder)
• Pre-treatment for chemical peels or laser therapy

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

Hydroquinone topical creams and lotions are available in concentrations of 1-5% by prescription. It is not uncommon for hydroquinone to be combined with other lightening agents. Topical steroids in low doses can help reduce the chance of skin irritation, while topical retinoids can help increase efficiency of treatments. Studies indicate that combination creams containing 4% hydroquinone, a steroid, and tretinoin are most effective (Grimes).

You may remember seeing low concentration hydroquinone topicals on retail shelves in non-prescription products. As of September 2020, the CARES Act re-categorized hydroquinone to be a prescription-only treatment. This change was made to address the misuse of hydroquinone for all-over skin lightening purposes. Using too much hydroquinone over an extended period of time can lead to a condition called ochronosis (Faridi). This condition causes blue-black pigmentation of the skin that is resistant to treatment.

Hydroquinone has been used for nearly 60 years, and is considered the “gold standard” depigmenting agent (Bandyopadhyay). It is the most frequently prescribed treatment for epidermal melasma worldwide. However, there are some side effects that may occur even when used correctly, such as:

• UV light sensitivity: Hydroquinone treatments cause the skin to be much more susceptible to damage from UV light. Taking extra precautions to protect treatment areas from the sun – like using sunscreen and wearing protective clothing – is essential for the best outcome.
• Swelling and tenderness of treatment area: While mild swelling and tenderness may be expected from hydroquinone treatments, you should note whether it is getting worse as you continue treatments, as this may be an indicator that the concentration of hydroquinone is too high.
• Skin irritation, stinging, and redness: Hydroquinone can cause these reactions in some people, which is why creams often also include steroids and retinoids. Some people may also experience allergic contact dermatitis when using hydroquinone. Any reactions you have to hydroquinone should be discussed with your doctor so they can adjust or change your prescription as needed.

How quickly do treatments with hydroquinone in skincare work?

Hydroquinone treatment plans typically last up to 3 months. While doctors may prescribe longer treatment periods in specific scenarios, the use of hydroquinone should generally be stopped if there has been no improvement in problem areas after 3 months.

Fortunately, hydroquinone treatments typically work for most people. For example, one study revealed that after a 12-week treatment plan, 85% of participants were satisfied with hydroquinone treatments, and 90% of participants no longer felt the need to hide their skin discoloration (Grimes).

Your doctor may start you at a lower dose/application frequency for the first week of treatment to determine how your skin reacts before instructing you to increase your dose.

Read More:

• What Are Possible Side Effects Of Hydroquinone For Your Skin?
• Understanding Hydroquinone For Melasma

References

• Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303-309. doi:10.4103/0019-5154.57602
• Faridi W, Dhamoon AS. Ochronosis. [Updated 2021 Aug 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560534/
• Grimes PE, Ijaz S, Nashawati R, Kwak D. New oral and topical approaches for the treatment of melasma. Int J Womens Dermatol. 2018;5(1):30-36. Published 2018 Nov 20. doi:10.1016/j.ijwd.2018.09.004
• 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.

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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.