Hydroquinone is a topically applied, depigmenting agent (normally in the form of a prescribed cream), used to brighten areas of darkened skin such as freckles, age spots, chloasma, melasma or stubborn pigmentation caused by pregnancy, hormones or injury to the skin. Hydroquinone works by decreasing the formation of melanin (pigment) in the skin.
What is all the hype about this drug?
The use of Hydroquinone has become extremely controversial over the years. So much so that its use in some countries is banned. The reason for this is both good and bad, depending on how one “looks at the coin”.
To this day, Hydroquinone remains the gold standard for the treatment and removal of stubborn hyperpigmentation. That sounds like a good thing, right? Well, have you ever heard the expression, “too much of a good thing can be a bad thing”? Sadly, this is the case with Hydroquinone. Its incredible effectiveness in treating pigmentation has led to its abuse and overuse, resulting in negative effects. Negative effects, which in some cases are irreparable.
When Hydroquinone is prescribed properly, and the dosages, application and length of use are strictly controlled by a Doctor guiding their patient/s, the results and outcomes are nothing short of spectacular. The results are fantastic, provided the patient remains compliant to ensure that the skin can be safely managed. When an experienced doctor and a compliant patient work together to improve the patient’s condition, everyone walks away as a winner.
The problem arises when the drug is used in too high a concentration, too often for way too long, and the patient applying the product is not being properly assisted, guided and monitored. There have been cases where patients have used HQ on-going for years at a time, resulting in depigmentation (loss of pigment) or damage to the skin because they have had no medical guidance. HQ should only be used for a maximum of about three months at a time in controlled doses and allowing the skin time to properly settle and adjust between periods of usage. It is not the kind of product that is made for long-term, ongoing use.
When HQ is used in an uncontrolled manner, side effects such as prolonged redness and sensitivity, extreme dryness, hypo-pigmentation (loss of pigment) or in cases of prolonged abuse, a condition called ochronosis can develop. Onchronosis is marked by papules (pimples and breakouts) together with dark, bluish-black pigmentation, and this condition is extremely difficult to treat or reverse.
The Bottom Line
Due to the extensive damage caused by this product in the past due to incorrect usage and abuse, it has been branded as somewhat of an “evil” drug and has unfortunately earned itself a bad name that has not been rectified over the years. In some countries, it remains banned and branded as a dangerous medication. Sadly, there is still plenty of HQ available on the informal, unregulated market, which only compounds its bad reputation.
In South Africa, Hydroquinone is still available via prescription from a medical doctor, but in most cases, doctors are wary of prescribing this as an option, and it is usually only used as a last resort. While it has been shown that short, controlled usage periods yield excellent results with no harmful side effects, history and the terrible damage caused in the past have not made for an easy comeback for Hydroquinone.