Interest in hydroquinone is back but with its problematic history, is this a good thing? Below doctors and dermatologists debate the stigmatised ingredient and its effect on hyperpigmentation.
Since its discovery in the early 1800s, hydroquinone has had a problematic history in skincare. Primarily used for photographic development, hydroquinone was quickly recognised and heralded for its lightening properties, proven to even and rebalance hyperpigmentation in skin.
However, while hydroquinone developed a bold reputation for skin lightening intimately tied to colourism, it has also been exposed to overuse leading to medical complications such as ochronosis, liver and kidney damage. So is hydroquinone actually ever safe to use? Do dermatologists stand by its benefits and can it be safely incorporated back into our skincare routines?
We asked some of the UK’s leading dermatologists and doctors to weigh in on the use of hydroquinone in skincare.
How does hydroquinone work?
Since its integration into beauty, hydroquinone has been marked for its effectiveness. “Hydroquinone is an active inhibitor of tyrosinase, an essential enzyme in the synthesis of melanin, the pigment that gives colour to the skin,” explains Dr Mica Engel, medical director at Cosmetica London.
“It causes slow structural changes in the membranes of the melanocytes (the cells responsible for melanin production), accelerating their degradation. The potent and active skin lightening effect makes hydroquinone the most used depigmenting agent in the treatment of melasma, spots, freckles, post-inflammatory hyperpigmentation.”
“Despite being quite potent, its results usually appear after two months of continuous use. After this period, spots will lighten, becoming less evident, and some disappear, leaving the skin with a more uniform tone and a radiant appearance.”
Why is hydroquinone considered dangerous in skincare?
While approved for use in the UK, US, EU, Japan and Australia, hydroquinone is banned as an ingredient to be purchased over-the-counter and doctors are only allowed to prescribe a concentration less than 2% due to the medical implications it can have on the skin and body.
“Hydroquinone is ‘cyto-toxic’ meaning it lightens skin by killing melanin-producing cells within the skin cells,” explains Ada Ooi, facialist and skin expert. “This process can be dangerous, making your skin extremely fragile, and in some cases photosensitive, leading to reverse hyperpigmentation.”
“With prolonged use (or at a concentration over 2%), some may also develop ochronosis (brown pigments that spread and accumulate in connective tissue, creating patches with blueish-black caviar like lesions), which can be further worsened with any sun exposure. Studies have also shown that traces of hydroquinone can be found in the liver and kidneys while some formulations also contain mercury, leading to a higher risk of toxicity.”
It’s important to note that hydroquinone’s dangerous reputation is due to unregulated use – use tied in to high percentages, a prolonged use over a period of months and insufficient SPF protection to prevent sun damage and re-pigmentation in the skin.
What are its ties to colourism?
Hydroquinone has also been extolled as an ingredient for lightening the skin, a popular yet hazardous method that is widespread among Africa, Asia, Latin America and the Caribbean. Intricately woven into European colonialism and the western ideology that lighter skin is deemed more desirable with economical, political and social implications, many countries (specifically India and Africa) have been influenced by this archaic ideal, resulting in the dangerous, illegal and inappropriate use of hydroquinone and other active ingredients such as steroids to lighten the skin.
This kind of permanent skin bleaching has then left many individuals dealing with visible blood vessels, thinning of the skin, uneven and patchy skin colours, redness, stinging, irritation and increased risk of skin cancer. Excessive use, combined with steroids has also exposed hormonal disorders, liver and nerve damage, or if pregnant, foetal abnormalities.
The benefits of hydroquinone
While there are definitely side effects and complications caused by ill-use of hydroquinone to be aware of, there are also safe and approved practices when incorporating hydroquinone into a skin routine.
“Hydroquinone is the gold standard medication for the management of hyperpigmentation and conditions of pigmentation,” says Dr Ifeoma Ejikeme, founder and medical director of Adonia Medical Clinic.
“It is an ingredient that, for the right patient, can be very helpful in initially treating hyperpigmentation but it should only ever be used under the guidance of a doctor. You would need to see your doctor or book into the clinic for an assessment to see if you are suitable for treatment.”
How to safely incorporate hydroquinone into your routine
“Hydroquinone can be used safely under the direction of a doctor in the short term, but it needs to be used judiciously,” says Dr Rabia Malik, holistic aesthetic doctor and founder of Skin W1. “I think long term it’s more important to have a consistent skin care regime that incorporates the daily use of vitamin C and A as well as a broad spectrum SPF (minimum SPF 30) to keep pigmentation and scarring at bay.”
“The use of hydroquinone needs to be incorporated under guidance from a doctor so the usage and time can be monitored. It has a place in initial management by decreasing melanocytes, but it should only be used short term (in my experience – around three months) and results then need to be maintained with a good skincare regime and daily sun protection, which needs to be continued lifelong to keep pigmentation under control.”
Are there hydroquinone alternatives?
Even with approval from some doctors, there are other skin experts who would prefer to use alternatives as a hyperpigmentation treatment.
“There are other much safer alternatives such as alpha arbutin that, over time, works to diminish the appearance of scars, acne and pigmentation and provides an even skin tone,” says celebrity aesthetician Mimi Luzon.
“Often in mild cases, there are other active ingredients you can reach for as a first step, from retinyl palmitate to vitamin C. No skincare routine would be complete without SPF to protect your skin from future damage,” advises Dr Lauren Hamilton, practitioner at GetHarley.