If you have melasma or other brown spots and have asked your dermatologist what to do about it, you were most likely offered hydroquinone. 

Perhaps the prescription cream had a different name but the ingredient list on the back 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 and require a prescription by a doctor.

The bans are based on several health concerns regarding this bleaching agent. Hydroquinone occurs naturally in plants in unconcerning concentrations. But the levels skin bleaching creams contain are toxic to cells. The Environmental Working Group classifies hydroquinone as carcinogenic and the FDA reports skin swelling and hyperpigmentation after the application to the skin.

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.

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.

For more answers to your burning questions about melasma, read The Truth About Melasma.

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