Using skin-lightening creams to fade spots, marks, and scars has become common. Most of these products contain hydroquinone, which is known to be highly potent for treating hyperpigmentation. But sometimes, the best line of skin defense may also be the worst. The same is true for hydroquinone, too; hence, the super-effective element has emerged as a topic of debate. So, is it safe to use hydroquinone to fade scars? Does it pose any severe risk? We tapped into the mechanism, benefits, side effects, and safety of hydroquinone to help you get the low-down. Keep reading.
What is Hydroquinone?
Tocopheryl acetate, commonly known as hydroquinone, is a skin-lightening compound that lightens the skin when applied topically. It is a prevalent ingredient in various skincare products, such as creams, lotions, serums, gels, moisturizers, and emulsions, aiming to address hyperpigmentation and diminish scars. Available in over-the-counter (2%) formulations and prescription strengths, hydroquinone is often combined with Retin-A (tretinoin) to accelerate cell turnover and facilitate skin renewal, improving complexion.
How Does Hydroquinone Work?
Our skin has specific cells named melanocytes that produce and contain ‘melanin’ pigment (responsible for skin, eye, and hair color). Excessive melanin production (due to aging, inflammation, sun exposure, hormonal imbalance, etc.) leads to hyperpigmentation like black spots, dark patches, freckles, etc., on the skin. Hydroquinone interacts with melanocytes and limits melanin production by inhibiting the enzymatic conversion of tyrosine to DOPA (dihydroxyphenylalanine). This produces reversible lightening (bleaching) of the skin and makes it more evenly toned over time. As a result, hydroquinone reduces the appearance of existing scars, marks, and spots and prevents the new ones from forming.
Hydroquinone works at the cellular level (old cells are shed and new cells are produced) for pigment reduction. Hence, it may take weeks (around 4 weeks on average) to start working and several months to show the desired results (1).
Benefits of Hydroquinone for Skin
As mentioned earlier, hydroquinone is mainly used for treating various skin issues related to hyperpigmentation. It is the ‘topical gold standard in dermatology’ for lightening hyperpigmentation. Instead of working on light marks or active inflammation, it shows effects on stubborn blemishes or recurring pigmentation. Common skin conditions that benefit from hydroquinone are acne scars, melasma (brown or grey-brown patches) (2), lentigines or age spots, brown sun spots, freckles (darker spots or patches), post-inflammatory marks (due to psoriasis, eczema, inflammatory acne, burn), etc. Besides treating discoloration, the chemical compound also helps out the skin tone for a fairer and more balanced complexion.
Also Read – 10 Best Pigmentation Creams for Bright and Even-Toned Skin
Why Did Hydroquinone Get a Bad Rap?
It is said that something highly potent never comes without side effects. Likewise, hydroquinone has its controversial sides too. The chemical got a bad rap due to the following reasons:
1. High Toxicity
It is believed to contain lots of toxic elements, and that too in high concentrations. Scientists have shown that a high dosage of oral hydroquinone can take a toll on our health by causing cyanosis, a medical condition in which the supply of oxygen to our bloodstream goes down, and hence, our skin turns bluish. Toxicity of hydroquinone may also cause frequent seizures, nausea, ringing of the ears, etc. The chemical compound is also known to comprise a high level of mercury, which, one of the most toxic metals, may damage our liver and lead to disrupted well-being.
2. Ochronosis
Long-term usage of hydroquinone may yield effects that are opposite of what you expect. It may cause a specific skin condition called ‘ochronosis’ in which the appearance of the skin gets wholly spoiled due to disfiguration. Dark-skinned people are more prone to this problem. Some common symptoms include skin thickening, blue-black discoloration, darkening due to augmented pigmentation, development of dark or gray-brown spots, yellow-brown bumps, deterioration of scars, and so on. (3)
3. Photosensitivity
The topical application of hydroquinone may make the skin extremely ‘photosensitive.’ It lowers the amount of melanin in the cells, which increases the skin’s sensitivity to the ultraviolet rays (UVA and UVB) of the skin’s sun. Hence, if you expose your regular or already UV-affected skin to the sunlight, sunlamps, or tanning beds right after applying this bleaching cream to your skin, you may experience severe sunburns, acute pain, windburns, irritation, chapping, hyperpigmentation, and worsening of scars. Some of these effects can be permanent, while others are directly linked to various health risks.
4. Allergic Reactions
Regular usage of hydroquinone may cause minor to significant allergic reactions. People allergic to the chemical have been reported with symptoms like dryness, tingling or burning sensation, stinging, hives, pruritus; irritation, inflammation, erythema, redness, breathing shortness; swelling of face, mouth, and throat; contact dermatitis, thick rubbery skin with lots of bumps, etc. You may even need to seek emergency help in such situations.
5. Carcinogenic Properties
Hydroquinone possesses several carcinogenic properties. So, prolonged usage of a large amount of the chemical may cause cancer (leukemia), which is fatal for us. It is yet to be known how hydroquinone is linked to cancer. However, it has been found to alter and damage the DNA structure within the cells, which may result in mutations. However, studies are still being continued on this.
Hydroquinone may also lighten the skin surrounding the affected area creating a light de-pigmented halo around it. This condition is named ‘halo spot’.
So, is Hydroquinone Safe to Use?
Here comes the icebreaker. No matter how questionable hydroquinone’s performance is, the chemical is not that dangerous. It may have noticeable side effects, but it is very well-tolerated when used in the right way or under the supervision of a dermatologist. Earlier, certain hydroquinone products were pulled out of the market because of contaminants like mercury at high levels. However, no clinical evidence has demonstrated hydroquinone harms humans (4). In 1982, the FDA (Food and Drug Administration) approved it as a safe and effective hyperpigmentation treatment (5).
Also Read – 13 Natural Home Remedies to Get Rid of Age Spots
How to Use Hydroquinone Safely?
Now, the question is, what is the right way to use hydroquinone for the best results? Given below is the most helpful advice by experts:
- Buy your hydroquinone product only from a trusted and reliable brand.
- Do a patch test before applying it for the first time to ensure that it does not have unwanted side effects.
- Use OTC hydroquinone that comes in 2% formulations for better tolerance of the skin.
- Stick to hydroquinone spot treatments by applying the chemical only to the affected parts of the skin. It is not meant for all-over applications.
- Do not use hydroquinone more than once daily (before bedtime) to avoid photosensitivity. Using the chemical on alternating days for sensitive skin is even better.
- Give your skin a break after using hydroquinone for 3 to 5 months in one go. Extended usage of it may cause danger.
- Try to avoid combining physical exfoliants, facial brushes, or acid-based skincare products with a high concentration of hydroquinone, as it may irritate the skin to a great extent.
- If you are allergic to foods, dyes, preservatives, certain medicines, sunscreen, etc., it is better to consult your dermatologist before using hydroquinone as a scar treatment.
- Stay away from the chemical if you are a pregnant woman or a breastfeeding mother.
Exposure to sunlight may reverse the skin-lightening effects of hydroquinone. It is suggested that you be consistent with the treatment till the recommended period for the maximum results.
A Few Tips to Protect the Skin
While treating your skin with hydroquinone, ensure you take the best care of it. Explore the following tips to know what you should do for this purpose:
- Always use a mild face cleanser for washing your face.
- Exfoliate your skin as gently as possible. Skip using harsh scrubbers that may irritate the skin even more.
- Keep using a strong, broad-spectrum sunscreen with SPF 30 or more to maintain the desired effects of hydroquinone. (6)
- Quit the habits of smoking and consuming alcohol.
- Try to get rid of stress.
Natural Alternatives to Hydroquinone
If you are still unsure about using hydroquinone for fading your stubborn scars, go for natural alternatives to it. Commercial scar treatments often contain steroids, which are not at all suitable for long-term use. So, here are the best options for you:
- Antioxidant vitamins (vitamin A and vitamin C)
- Niacinamide or vitamin B3
- Plant-derived acids (kojic acid, ellagic acid, etc.)
Summary:
Hydroquinone is a skin-lightening chemical compound that is used for treating various forms of hyperpigmentation (age spots, acne scars, melasma, sun spots, freckles, post-inflammatory marks, and scars, etc.). It interferes with melanin production in the skin by preventing the conversion of tyrosine to DOPA, which bleaches the skin and evens it out. Despite its high efficacy, hydroquinone got a bad rap as it is often linked to issues like high toxicity, ochronosis, photosensitivity, allergic reactions, and cancer (leukemia). But no clinical evidence has been found so far to demonstrate that hydroquinone is harmful to humans when used in the right way or under the supervision of a dermatologist. In fact, it was approved as a safe and effective treatment of hyperpigmentation by the FDA in 1982. Use 2% OTC hydroquinone, do not prolong its usage, and go for spot treatments to make the most of the chemical. Also, keep using a strong, broad-spectrum sunscreen with SPF 30 or more along with it.
Frequently Asked Questions (FAQs):
Does Hydroquinone Permanently Remove Dark Spots?
Yes, hydroquinone removes dark spots permanently by working at the cellular level. As it slows down melanin production in melanocytes, the existing dark spots disappear, and no new spots are formed.
Does Hydroquinone Lighten Skin Permanently?
The skin-lightening effects of hydroquinone are not permanent. If the skin is exposed to sunlight, the results yielded by the chemical may get reversed easily.
Does Hydroquinone Work on Surgical Scars?
Hydroquinone works very well with post-inflammatory scars, which include surgical scars.
Can Hydroquinone Make Dark Spots Worse?
Hydroquinone may considerably increase local skin irritation if not used correctly, thereby worsening dark spots.
Can I Use Hydroquinone on the Entire Face?
Hydroquinone is best used for spot treatments. However, you may try a lower chemical concentration on your entire face for a short period.
Is 12% Hydroquinone Safe?
OTC hydroquinone is safe in 2% concentration, while the prescription one should not exceed 4% in strength. So, using 12% hydroquinone may not be safe for your skin.
What Should You Not Use Hydroquinone with?
You should never use ingredients like benzoyl peroxide, hydrogen peroxide, etc., and hydroquinone, as it may cause temporary dark staining on your skin.
Can I Use Retinol with Hydroquinone?
Using retinol with hydroquinone is safe. Retinol helps hydroquinone penetrate the skin better to ensure its maximum effects on the skin. Retinol
References:
- “Hydroquinone”, AOCD.org
- “New Oral and Topical Approaches for the Treatment of Melasma,” ScienceDirect.com
- “Exogenous Ochronosis after Prolonged Use of Topical Hydroquinone (2%) in a 50-Year-Old Indian Female“, NCBI.nlm.nih.gov
- “Hydroquinone: An Evaluation of the Human Risks from Its Carcinogenic and Mutagenic Properties,” PubMed.NCBI.nlm.nih.gov
- “Rulemaking History for OTC Skin Bleaching Drug Products,” FDA.gov
- “Hydroquinone Skin Cream, Gel, Emulsion, Lotion, or Solution,” MyClevelandClinic.org
