3 Hydroquinone side effects and how to overcome them
Melasma is a dark patch of skin affecting primarily sun-exposed areas. These dark patches are mostly bilateral (affecting both sides of the face) and do not have a definitive border. If you have melasma, you will also know that it is difficult to treat with a single ingredient and once treated, there is a good chance that it can relapse.
Hydroquinone, a tyrosinase inhibitor, has long been documented as one of the most effective agents for managing melasma. It works by reducing melanin production, the pigment responsible for skin colour. There are other tyrosinase inhibitors, but studies show the effects of hydroquinone are superior to other tyrosinase inhibitors.
In this article, we discuss the three common side effects of Hydroquinone and how to overcome these challenges.
1. Hydroquinone can cause ochronosis
Hydroquinone has a limited treatment duration due to the risk of ochronosis (greyish discolouration of the skin)
"Melasma can take 6 months or longer to treat. Should I even start on Hydroquinone long term due to the risk of ochronosis?"
Hydroquinone has been shown to be safe and effective when used under medical supervision, even beyond three months. The risk of ochronosis is seen only at very high doses, when applied to large areas for a long period of time. The risk is also higher in people with darker skin tones.
To overcome this challenge, most protocols have the patient stay on hydroquinone triple therapy for 1-2 months, then take a break. During this break, other ingredients are introduced such as Azelaic Acid, Vitamin C and Tranexamic Acid.
2. Hydroquinone may worsen hyperpigmentation
Stopping hydroquinone mid-treatment can cause rebound Hyperpigmentation.
Melasma is a chronic condition and is likely to relapse once treatment is ceased. Hence, it is important to have the right maintenance therapy or treatment protocol in place to prevent relapse when you are taking a break from Hydroquinone.
The need to taper off Hydroquinone (to avoid rebound hyperpigmentation) is only necessary if therapy has been established for a very long period of time.
3. Hydroquinone can cause irritation
Triple combination therapy helps users overcome irritation
Hydroquinone has been shown to be well-tolerated at concentrations of 2-4%. Stinging and irritation are common when the Hydroquinone concentration exceeds 10%. When low-dose Hydroquinone is combined with Tretinoin, the irritation from Tretinoin is often misconceived as Hydroquinone. To reduce the risk of irritation, a triple combination containing hydroquinone, tretinoin and hydrocortisone is often prescribed.
What are the treatment options for melasma once I stop Hydroquinone?
Other non-hydroquinone based therapies include:
- Alpha arbutin
- Niacinamide
- Liquorice Root
- Soy Bean
- Vitamin C
- Tretinoin
- Kojic Acid
- Glycolic Acid
Author: Helen Huynh B. Pharm MPS
References
1. Doolan, B et al (2021) "Melasma". Australian Journal of General Practice. vol50, issue 12.
2. Chan R, Park KC, Lee MH, et al. "A randomized controlled trial of the efficacy and safety of a fixed combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinne 4% cream in Asian patients with moderate to severe melasma." Br J Dermatol. 2008; 159: 697-703.
3. Sarka, R et al (2013) "Cosmeceuticals for Hyperpigmentation: What is available?." Journal of Cutaneous and Aesthetic Surgery. Jan-Mar; 6(1): 4–11. doi: 10.4103/0974-2077.110089
4. Navarette-Solis, J (2011) "A Double Blind, Randomised Clinical Trial of Niacinamide 4% vs Hydroquinone 4% in the Treatment of Melasma." Journal of Dermatology Research and Practice. doi: 10.1155/2011/379173
5. Banyopadhayay, D (2009). "Topical Treatment of Melasma." Indian Journal of Dermatology. 2009 Oct-Dec; 54(4): 303–309.
