April 16, 2020 Understanding Hydroquinone For Melasma
There are a variety of viable treatment options for melasma, some of which are more effective than others. Any authority on skincare will tell you that hydroquinone is among the well-established first-line treatments for melasma. That’s because it works.
Understanding Hydroquinone For Melasma
Hydroquinone is a demonstrably effective treatment option for melasma. It is often referred to as the “gold standard” treatment for melasma treatment, and that status has been validated across many studies (Grimes).
Hydroquinone has been used as a depigmenting agent with applications for a variety of different skin conditions for half a century. It works well as such for a variety of reasons, the primary one being that it directly inhibits the formation of the cells responsible for melasma (Bandyopadhyay).
There have been numerous attempts throughout the years to find new and alternative means to fight melasma as it is a persistent skin condition that affects innumerable people worldwide. In many of the studies associated with those attempts, hydroquinone is used as a baseline comparison to determine the efficacy of these treatments because it is so well established and accepted as a way to treat melasma.
Side Effects Associated With Hydroquinone
There are some known side effects of hydroquinone. Primarily, the agent is intended to “bleach” the skin and can be used to excess with ensuing negative results. The medication should only be used as prescribed, or, in the case of over-the-counter hydroquinone, according to the manufacturer’s instructions. It is always important to use a sunscreen with hydroquinone as this medication makes the user especially sensitive to UV light.
Furthermore, hydroquinone has been known to be associated with swelling and tenderness in some cases. Hydroquinone works through the suppression of an enzyme called tyrosinase, a precursor to melanin. This suppression is associated with some mild swelling and can be a perfectly normal part of hydroquinone use. However, this can be a sign that your medication contains a concentration of the medication that is too high, so swelling should be monitored closely for signs of increasing severity.
Ultimately, hydroquinone is a powerful medication and can cause side effects if used improperly, but is safe when used as prescribed.
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Debunking The Controversy Surrounding Hydroquinone
Prospective users of hydroquinone might have some concern about the medication because the product is the subject of some scrutiny. There are some objections to perceived side effects of the medication.
A common misconception considering that hydroquinone is a universal standard for melasma treatment is a paradox. Some people worry that hydroquinone can make melasma worse. This concern stems from internet rumors that this medication might actually cause melasma rather than cure it. However, hydroquinone has never been credibly implicated in causing melasma.
Another concern is that hydroquinone can cause a skin condition known as ochronosis. In the US, this very rare side effect has been reported only by prolonged use of the medication alongside limited use of sunscreen.
Finally, there is some concern that hydroquinone might be hazardous. This stems from how the agent is manufactured: it is produced from benzene, a known carcinogen. However, the metabolites produced from benzene, including hydroquinone, have been conclusively shown not to cause malignant cell changes (Grimes). Ultimately, the medication has been used for over 60 years, and several reviews of the literature to address this specific concern have not produced an example of an individual who developed cancer as a result of using hydroquinone for melasma (Grimes).
What Kind Of Hydroquinone Treatment Is Right For Me?
There are two main ways in which hydroquinone is sold.
- Hydroquinone is carried at drug stores as an over-the-counter medication at strengths up to 2%.
- Hydroquinone is also available as a prescription at strengths up to 5%.
Which type should you choose?
The answer isn’t as straightforward as it may seem. This is because there are a multitude of causes of melasma, some of which are not fully understood.
To compound its difficulty to effectively treat, melasma differs in how it manifests from person to person: some will exhibit symptoms primarily in their outer layer of skin, while others will have the hyperpigmentation down deeper. Melasma severity and appearance will also differ according to your skin type. This means that personalized treatment is ideal.
Prescription Melasma Treatment
For those of you with darker skin complexions, elevated hormone levels from pregnancy or hormonal birth control, or the love of a good, long summer tan, melasma is likely all too familiar. You’ve dealt with the unappealing dark splotches across your face for long enough to know that their treatment can feel impossible at times. For many a prescription melasma treatment from a board certified option is the best option.
- Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303–309. doi:10.4103/0019-5154.57602 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807702/
- 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 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374710/
- Oakley A. Bleaching cream. DermNet NZ. https://dermnetnz.org/topics/bleaching-agents/. Published 2008. Accessed April 16, 2020.
About the author
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 ...