Everything You Need to Know About Hydroquinone
What is contained in your skin lightening cream? Unfortunately, not many people can answer this question. Choosing to lighten your skin is a decision that you get to make alone.
However, you don’t have to walk through the process alone; it is our goal to promote safe skin lightening and keep you in the loop about potentially harmful products while at it.
Bleaching creams contain active ingredients which are responsible for skin lightening. Hydroquinone is one of the most common and as such has aroused a lot of interest. Whatever questions you have about it, we’ve got you covered.
Here is everything you need to know about hydroquinone.
#1. What is Hydroquinone?
This is an organic agent topically applied to remove pigmentation and dark spots from hyper-pigmented skin. It is contained in skin whitening products and treatments either as the only active ingredient or as a combination with other substances to enhance the results.
Creams with different concentrations  are the most common. They contain concentrations of 2, 4, 6, 8 and 10%. Both 2% and 4 % creams are commercially available. While the former can be easily bought over the counter, the latter requires a prescription to purchase.
The 6%, 8% and 10% concentration creams are stronger and only available from compounding pharmacies . They are only prepared with a prescription from a certified physician.
TIP: Do not use Hydroquinone for more than 4 months in a row and for best results alternate the usage with arbutin, azelaic acid, kojic acid and other lightening agents.
#2. How Does Hydroquinone Work?
Now that you know hydroquinone removes pigmentation, can it lighten your skin? Indeed it can. It works by interfering with the production of melanin. Melanin is the skin pigment that determines our complexion. It is formed in structures called melanosomes by the help of an enzyme called tyrosinase.
Hydroquinone slows down the formation of melanosomes and destroys their activity by inhibiting the enzyme tyrosinase. With continued use it completely destroys melanocytes, the cells that make them. Since these cells are located at the bottom layer of the skin, it impairs your skin’s melanin production  at the point of application.
#3. What is Hydroquinone Made Of?
Hydroquinone is a derivative of benzene what is a natural constituent of crude oil and is classed as an aromatic hydrocarbon. You know the smell around petrol stations? Well, it's coming from benzene!
Benzene itself is colourless and highly flammable liquid which is human carcinogen so most non-industrial applications have been limited.
Where else can you find benzene?
Well, it's not hard to find it around us, actually. It's present in:
#4. Uses of Hydroquinone
Due to its skin bleaching effect, Hydroquinone has been prescribed by dermatologists and cosmetologists alike to effectively lighten pigmented skin. It is used to clear effects of old age on the skin and pigmentation that comes from various skin problems. Here are some conditions which hydroquinone topical creams are used to treat.
This is a skin condition  that causes hyper-pigmented lesions on the face but can also occur on the neck and back of forearms. The condition, which is known to worsen with exposure to sunlight, is partly linked to prolonged periods in the sun and partly to hormonal changes. This is because it is common at puberty, during pregnancy and with use of hormonal birth control.
The hyperpigmentation is not just topical, it stems from the skin cells responsible for making melanosomes (the site for melanin synthesis). A malfunction of the cells cause excess production of melanin which manifests in both the top and bottom layer of the skin.
Hydroquinone works by targeting those same cells as explained above. With reduced melanin production  at the site of application, the condition is gradually reversed and significant lightening of the skin becomes evident.
Acne scarring  comes as a result of inflamed lesions and affects people of all ages and genders. Acne manifests as follicles or pores full of excess sebum and dead microorganisms. When they beak, they may do so either closer to the skin or extend way into the follicle wall. The contents are emptied under the skin and may destroy the skin tissue. In the process of repairing itself, the skin may not return to its original state which leads to scarring.
On the other hand, melanin production is the body’s way of defending itself against harmful UV rays that enter the skin through the broken skin. This triggers excess amount of melanin production which leads to post-inflammatory hyperpigmentation. Hydroquinone is used to lighten this.
These are also called solar lentigines or age spots . As the body produces more and more melanin to protect itself from UV rays, some of it accumulates in various places after years of exposure. This leads to formation of patches darker than the normal skin complexion.
Lentigines are common in areas that receive most exposure like the face, shoulders, arms and legs. They give the skin an older look and mostly affect people who are 40 years and above. Hydroquinone is considered one of the best treatments for this condition.
#5. Is Hydroquinone a Safe or Harsh Chemical?
The safety or harshness of hydroquinone greatly depends on several factors. Exposure to sunlight, use alongside specific substances like benzoyl peroxide and use of creams with concentrations higher than 4% can render it harmful. Other underlying medical conditions can also predispose you to harmful reactions from hydroquinone.
#6. Hydroquinone Side Effects
Common hydroquinone side effects  are slight burning on the point of application, temporary dryness, irritation and redness. These should clear within a few days of use. Some adverse effects which may warrant contacting a doctor include formation of blisters on the skin, contact dermatitis, breaking of the skin and extreme dryness and bleeding.
Allergic reactions are not very common but they would be accompanied by severe irritation and burning, swelling of treated area and other body parts, and labored breathing. These call for an emergency visit to the doctor. Other effects may include:
Due to interference with melanin production, hydroquinone increases your skin’s exposure to direct UV penetration . This can cause severe burns to your skin and consequently make your condition worse if you continue using hydroquinone on sun damaged skin. Its use should always be accompanied by sunscreen come rain or shine and evasion of sun exposure.
This is the bluish-black pigmentation that has been associated with hydroquinone use among darker skinned women. It also causes a characteristic thickening of the skin. Although this condition  which is said to be irreversible was earlier on associated with use of higher concentration products, cases related to low concentration creams have also been reported over a period of time.
Can it give you cancer?
A research  done by the US National Toxicology Programme showed prevalence of tumors in mice treated topically with hydroquinone. When given orally, carcinogenic activity was noted in both male and female rats.
In humans, topical use  of hydroquinone has not been directly associated with any cases of skin cancer.
Can you use it during pregnancy/ breastfeeding?
It is not advisable to use hydroquinone without consulting your doctor if you are pregnant or breastfeeding.
Can you use it with Benzoyl Peroxide or Resorcinol?
Use of hydroquinone  with peroxide compounds can lead to mild staining of the skin and should be avoided. Its combination with resorcinol has been linked to many cases of ochronosis.
#7. Is it Safe to Use Hydroquinone on Face/Intimate Areas?
With the proper adherence to instruction, the face is able to tolerate it. However, common and adverse effects cannot be ruled out due to hydroquinone’s instability and easily oxidised nature .
Use on or in intimate areas such as the anus, vagina and nipples is a different story altogether. These are more sensitive and the safety cannot be guaranteed. You should not use creams containing hydroquinone on intimate areas!
#8. Is Hydroquinone FDA Approved?
In 1982, Food and Drug Administration (FDA) limited the use of hydroquinone to 2% concentration in over-the-counter creams pending further investigations. However, citing data gaps, conflicting results and the lack of enough evidence to suggest otherwise, the agency recounted their 1982 stand. It declared all OTC skin whitening creams no longer GRASE-generally-recognized-as-safe and effective in 2006.
This was further reinforced by evidence backed reports of exogenous ochronosis and carcinogenicity that resulted from hydroquinone use. FDA maintained its decision  despite appeals by American Health and Beauty Aids Institutes and the Dermatology Section of the National Medical Association (NMA). To date, only one hydroquinone 4% cream has been FDA approved.
#9. Is Hydroquinone Banned Anywhere?
Hydroquinone use has been banned in several countries and regions . In Canada, its use in cosmetics is prohibited. It was banned in European Union in 2001 due to concerns of Leucoderma and exogenous ochronosis. Japan and UK have not been left behind either; in fact the sale of skin lightening products containing hydroquinone and other harmful chemicals like mercury is prohibited in the UK.
Despite public sensitization on possible adverse effects of some skin lightening agents and subsequent bans, business in this sector is on an all-time high. A BBC  13th January 2017 report states that despite it being illegal to stock and sell skin lightening products, business people are still doing it to satisfy the insatiable public demand.
Skin lightening is also very prevalent among the African and Asian communities. A World Health Organization research  recorded skin lightening use among Chinese women at 40%, 61% in India and 77% in Nigeria.
#10. Where Can You Buy Hydroquinone Creams?
The creams can be bought online or over the counter. Online stores are awash with hydroquinone creams of all strengths, brands and quantities. Depending on your location, you may or may not need a prescription to buy them. Some of the online pharmacies where you can buy hydroquinone include Walmart, CVs, Walgreen, Albertsons and eBay among others.
Due to hydroquinone potential side effects, ONLY buy it from reputable sources!
You can easily buy over-the-counter creams from your local pharmacy or beauty shop. In most areas, strengths of 4% and more require a prescription from your doctor.
#11. Hydroquinone Price
There is no specific pricing policy for hydroquinone. The price that you buy whether online or over-the-counter may depend on several factors. These include where you are buying, the brand, combinations and quantity among other factors.
Different strengths are also bound to cost differently. For example, a tube of 28.35g 4% hydroquinone ranges between $36.50 - $54.25 in common online pharmacies. You can find another price list of different brands and quantities of 2% strength here. Higher strengths are prepared by compounding pharmacies upon order.
TIP: Creams containing hydroquinone are dangerous to your eyes so take care when applying it around the eyes!
#12. How is Hydroquinone Best Taken?
The tube or bottle cream should be handled with clean hands at all times. The cream is for topical use only. If you are applying on a part of your skin, ensure that it is clean and dry.
If you are using it on the whole body take a bath first and dry yourself thoroughly. Apply it on a small section of your skin and observe the results for 24 hours. This is sufficient time to judge your skin’s sensitivity to the cream.
If the trial area becomes irritated with a severe burning sensation, clean with plenty of water and consult your doctor for an alternative product. Mild reddening of the area is expected with initial application and is not reason enough to stop use.
Application  should be done thinly over your body or the affected area twice a day; in the morning and before bed time. Use sunscreen on the affected area during usage.
The results should be evident after two months of use, if not, discontinue usage and consult your doctor. The product should not be used by children below the age of 12 without a pediatrician’s approval.
#13. How Do I Store and/or Throw Out Hydroquinone?
Ideally, the cream should be contained in a dark and airtight tube or bottle to protect it from light and air. Light and air can oxidize it rendering it ineffective.
One sign of oxidized cream is turning brown. It also requires storage in room temperatures  i.e. 20 - 25o C (68o – 77oF). Keep it in a medicine drawer away from children and ensure it’s kept dry at all times.
TIP: It’s essential that your hydroquinone product is be packaged in an opaque container that minimizes air exposure.
When you are done using it or it expires, dispose the container as directed on the label. Do not flush it down the toilet. You can also check with your pharmacy whether they have a take - back policy for expired drugs.
#14. How to Make Hydroquinone Work Faster?
As with other treatments, especially for conditions that affect how you look, it is perfectly normal to desire faster results. Having that said, are there ways of getting faster results with hydroquinone use? Actually, there are a few:
Combination with Retin-A (Tretinoin)
Retin-A is a form of vitamin A that comes packed with a host of skin benefits. Besides being an effective acne treatment, it enhances cell turnover and boosts collagen production. This helps in improving skin texture, combating skin damage and fading pigmentation.
That’s not all, Retin-A keeps hydroquinone from oxidising and enhances its penetration into the skin. These qualities help in boosting Hydroquinone, consequently leading to faster results.
How to use Hydroquinone and Retin A?
If you have already been using Hydroquinone, you can gradually introduce Retin A into your skin lightening routine. Here are a few pointers:
Hydroquinone is usually applied twice but for Retin A, use at night only
Start by applying twice weekly and gradually increase frequency to every night
Only apply a thin film of tretinoin to cleansed, dry skin then follow with hydroquinone
While using the combination, don’t use other product that might irritate your skin
Expect a little irritation and flaking at the beginning but if it worsens or your skin becomes red and sore, stop using and resume when your skin normalizes
Always wear sunscreen with a SPF of 30 and above
Combination with Kojic Acid
Research has shown that both Hydroquinone and Kojic acid are similar in performance. ‘Superior’ results are however experienced when the two are used in combination. These active ingredients work similarly by inhibiting melanin production, which eventually leads to lighter skin.
To speed up things a little, go for a skin lightener that contains at least Kojic acid 1% and Hydroquinone 2% and use as per the directions.
Combination with Acid Peels
This option is usually used with moderate to severe cases of hyperpigmentation. One of the characteristics of such cases is hyperkeratosis, a thickening of the outer layer of the skin. Chemical peels are meant to get rid of the excess keratin layers to enhance absorption of hydroquinone
Glycolic acid is mostly used and may require serial sessions; about once in a month till desired results are seen. This works for all skin types. Other ways of utilizing the peels would be to use products that combine hydroquinone with AHA or BHA exfoliants to reap the benefits of both in one package.
#15. Hydroquinone Creams of Different Strengths
Hydroquinone is available in varying strengths. Use is dependent on the severity of hyperpigmentation.
Hydroquinone 2% is readily available over the counter. It’s a common constituent of most skin lightening creams under different brand names. It’s used to lighten acne lesions and post inflammatory pigmentation. It is effective though it may take a longer for the effects take hold.
Hydroquinone 4% is the highest concentration available in most over-the-counter stores. It’s used to treat persistent skin discoloration caused by freckles and acne. It’s also the go to product when it comes to aesthetic skin lightening.
Hydroquinone 8% is a skin lightening agent that is stronger than what commercial shops and cosmetic outlets have. It’s best used on prescription and under observation to treat severe melasma and sun damage. Continued and uncontrolled use can lead to adverse effects.
Hydroquinone 10% is a high strength lightening cream that is only available from compounding pharmacies. Its use is prescribed by dermatologists for treating the severest cases of hyperpigmentation.
There you have it! Remember our promise to walk with you all the way? While our best bet lies with all natural skin whitening products, your safety is our greatest concern.
Just to bring you up to speed with the side effects of hydroquinone, they include; skin dryness, initial mild irritation and redness. More adverse ones may include abnormal skin breakage, bleeding, blistering and contact dermatitis. Your skin also becomes photosensitivity and you also have a possibility of suffering from exogenous ochronosis.
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Sonia Knight is the founder of be:skinformed.Apart from having her own experience with hyperpigmentation, Sonia has gained vast knowledge in the dermatology field. For more info on this, check out our about us page.