Hydroquinone (HQ) is the gold standard treatment for treating various forms of hyperpigmentation such as hormone-related melasma, post-inflammatory pigmentation and sun damage.
How does it work?
To understand how hydroquinone bleaching works, it is important to first have look at how melanin is formed. Melanin production in the skin starts with the oxidation of amino acids tyrosine and L-DOPA, catalysed by the enzyme tyrosinase. Since hydroquinone’s structure resembles that of tyrosine and L-DOPA, having it present means tyrosinase will grab hold of the hydroquinone instead of tyrosine. As a result, there’s less tyrosinase available for transforming tyrosine and L-DOPA which slows down melanin production.
By slowing down melanin production, skin becomes more evenly toned over time and dark pigmentation patches fade.
Although hydroquinone can be very effective for a number of indications, prolonged use can cause serious side effects that are hard to reverse.
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Using hydroquinone for more than six months leads to resistance to its lightening effects for more patients. After this period, the treatment no longer affects the dark spots of melasma and its bleaching effects appear more pronounced in unaffected areas.
As the active melanocytes in the affected regions can no longer be influenced by hydroquinone, hyperpigmentation in these areas can worsen.
In rare, severe cases the prolonged use of high-concentration hydroquinone can lead to intense blue-black pigmentation. Ochronosis is more common among darker skin tones.
Hydroquinone can be harsh on the skin. Many HQ crèmes are formulated with retinoic acid to enhance hydroquinone’s bleaching efficacy, however, in some patients this combination can lead to irritant contact dermatitis.
Skin Atrophy and Telangiectasia
Some of the side effects with hydroquinone don’t even come from hydroquinone itself. A number of products on the market combine hydroquinone with ingredients such as retinoic acid, glycolic acid and topical steroids. However, prolonged use of such product can create a myriad of additional issues. For example, the combination of HQ, tretinoin and fluocinolone can lead to skin atrophy, telangiectasia and more stubborn pigmentation.
Topical steroids in HQ crèmes aim to suppress inflammation. However, topical steroids are effective only when treating trauma or disease – induced pigmentation (PIH). Therefore, topical steroids must be avoided when treating pigmentation not caused by inflammation such as melasma.
What are the alternatives?
Non-hydroquinone brightening agents can be prescribed as a healthy, maintenance system and to avoid local or systematic side effects associated with long-term HQ use.
ZO Skin Health offers comprehensive non-hydroquinone brightening system, designed for the treatment of non-specific discoloration (freckles, liver spots, uneven skin tone), prevent new spots for forming and improve skin texture.