Hydroquinones have been the standard of care in the US for over 50 years for treating skin pigmentary problems such as: melasma, chloasma, post inflammatory hyperpigmentation (PIH) and sunspots (lentigos). It’s mechanism of action is proposed to be that it competes with tyrosine in its conversion to melanin thereby leading to less pigment production by the melanocyte but it may also have a toxic effect on the melanocyte. Despite its long safety record, there is a growing opinion amongst state legislative boards to ban the use of hydroquinones. Just recently, Obagi stopped shipping hydroquinone products to Montana, New York, Massachusetts, and New Hampshire. In 2011, Texas banned the use of hydroquinones and a reinstatement of its use was veto’d by the Governor in mid 2013. The European Union has placed a ban on its use since 2001. Japan and South Africa have similar laws and there are strict guidelines in several countries in Asia and Africa. In 2006, the FDA put a temporary restriction on hydroquinones but ruled them safe after a several month investigation. So what’s the problem with this highly prescribed topical skin treatment?
There seems to be 3 factors going against hydroquinones:
- There is a question of whether hydroquinones are carcinogenic. In high concentrations (greater than the typical 4% found in medical offices) when used in mice, it has been shown to cause cancers. In a report from the American College of Toxicology and OSHA, hydroquinones are categorized as “mutogentic” with the potential to cause alterations in DNA and cancer. To my knowledge, there has not been a case of human cancer directly attributed to topical use of hydroquinones.
- Abuse of the hydroquinones can cause ochronosis which is a dark blue/black pigmentation of the skin. This seems to be a problem mainly in foreign countries where people are using higher concentrations (up to 10%) and not under medical guidance. Ochronosis is a very difficult problem to treat. Having lighter skin in Asian countries is a sign of wealth because your skin hasn’t been exposed to the sun while working in the fields. Abuse of hydroquinones is common in these countries.
- Many people seem to get a rebound hyperpigmentation that may be worse than the original problem. Because the product decreases the amount of melanin in the skin, it becomes more sensitive to the sun as well, leading to hyperpigmentation. Dr. Obagi has now recommended taking breaks from hydroquinone to allow the melanocytes to stabilize. He also never recommends using greater than 4% concentrations of hydroquinones. There are also a subset of people who are sensitive to hydroquinones, developing redness in the area its applied.
Last year, SkinMedica, the second largest skincare line in US physicians offices, discontinued production of hydroquinones after Lytera was introduced. Dr. Obagi (no longer associated with the Obagi skincare products) who has been a staunch supporter of hydroquinones, has a new skincare line promoting non hydroquinone pigment control.
Given the fact that there are now fairly good alternatives (ie LYTERA from SkinMedica) for treating hyperpigmentation conditions, it seems the use of hydroquinone will gradually be discontinued in the US. Negative sentiment seems to stacking up despite its long track record of safe usage.
Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.