If you have melasma, or other brown spots and have asked your dermatologist what to do about it, you were most likely offered hydroquinone. Maybe the cream he/she prescribed had a different name but the ingredient list of your product should reveal if hydroquinone is in it.

In Australia, concentrations up to 2% are available over the counter. In the US and most EU countries, non-prescription cosmetics that contain this skin-lightening ingredient are banned. Anything above 2% in Australia or any cream containing hydroquinone in the US and EU requires a prescription by a doctor.

The bans are based on several health concerns regarding this bleaching agent. The Environmental Working Group identifies hydroquinone as carcinogenic and the FDA reports skin issues like swelling and discoloration after the application to the skin [1].

Hydroquinone works in two ways. One way is by suppressing the melanin production through the inhibition of tyrosinase—the enzyme that turns melanin into its brown colour. The other way is the destruction of melanocytes—the cells that produce melanin. Because of the toxic effects on melanocytes, there are concerns that the skin is more vulnerable to sundamage and skin cancer when using products with hydroquinone.

This organic compound was not always meant to be utilised in skincare. Originally, it was used as a component in photographic developers. Several papers published in the 1980s reported about the toxic effect on melanocytes. The toxicity of the chemicals destroyed melanocytes and left workers in the photo developing industry with permanent white marks where the skin was in contact with the chemical [2][3].

The paradoxon is that even though hydroquinone inhibits pigmentation, it can over time cause hyperpigmentation. Reports provided to the FDA have claimed that women who applied over-the-counter products with hydroquinone, have experienced a skin condition called ochronosis. Ochronosis shows up with brown-grey or bluish-black lesions on the skin that are a result of an accumulation of this compound in tissue. The scandalous thing about this is that the FDA assumes hydroquinone was slipped in to cosmetics without being labelled by the manufacturers [4].

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References

1. Research C for DE and. FDA works to protect consumers from potentially harmful OTC skin lightening products. FDA [Internet]. 2022 [cited 2024 Apr 12]; Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products

2. Kersey P, Stevenson CJ. Vitiligo and occupational exposure to hydroquinone from servicing self-photographing machines. Contact Dermatitis. 1981;7:285–7.

3. Chivers CP. Two cases of occupational leucoderma following contact with hydroquinone monomethyl ether. Br J Ind Med. 1972;29:105–7.

4. Affairs O of R. Skin Products Containing Mercury and/or Hydroquinone. FDA [Internet]. 2023 [cited 2024 Apr 6]; Available from: https://www.fda.gov/consumers/health-fraud-scams/skin-products-containing-mercury-andor-hydroquinone