By Katina Gilmore, RN, LE
Licensed Esthetician and Registered Nurse
When dark spots, uneven skin tone or stubborn hyperpigmentation will not seem to budge, it can be tempting to reach for whatever promises to lighten them fastest.
One ingredient you may encounter is hydroquinone.
Hydroquinone has been used for decades to reduce excess pigmentation in the skin. It can be effective, which is exactly why understanding how and when it should be used matters.
This is not an ingredient I believe consumers should approach casually, particularly when purchasing skin-lightening products on their own.
What Is Hydroquinone?
Hydroquinone works by interfering with the process involved in producing melanin, the pigment that gives our skin its color.
Dermatologists may prescribe hydroquinone for conditions involving excess pigmentation, including melasma and other forms of hyperpigmentation. The American Academy of Dermatology continues to list prescription hydroquinone among treatments a dermatologist may use for melasma. (American Academy of Dermatology)
That is important because there is a distinction between hydroquinone being used as a medication under professional supervision and casually purchasing a skin-lightening cream containing hydroquinone.
In the United States, hydroquinone skin-lightening products are no longer legally marketed over the counter. The FDA advises consumers not to use nonprescription skin-lightening products containing hydroquinone and recommends discussing treatment options with a healthcare professional instead. (U.S. Food and Drug Administration)
One of the Biggest Concerns: Ochronosis
One potential complication that deserves particular attention is exogenous ochronosis.
Instead of creating the more even complexion someone may be seeking, exogenous ochronosis can produce persistent blue-black or gray-blue discoloration of the skin.
A systematic review of reported hydroquinone-associated cases found that ochronosis occurred disproportionately among people of African descent and people with Fitzpatrick skin types V and VI. Higher hydroquinone concentrations and prolonged use were common among reported cases. (PubMed)
For Black consumers, that is not an insignificant detail.
An ingredient being capable of lightening pigmentation does not mean that using more of it, using a stronger concentration or continuing indefinitely will produce better results.
Sometimes the opposite can happen.
Irritation and Allergic Reactions Can Happen Too
Hydroquinone can also irritate the skin.
Reported adverse effects include irritation, redness, inflammation, stinging, dryness and allergic contact dermatitis. The FDA has received reports involving rashes and facial swelling as well. (NCBI)
If your goal is to improve hyperpigmentation, repeatedly irritating your skin can be particularly frustrating because inflammation itself can contribute to discoloration in skin of color.
That is another reason why treating pigmentation should be more thoughtful than simply buying the strongest lightening product you can find.
What About Cancer?
You may have heard concerns about hydroquinone and cancer.
This requires some context.
Hydroquinone has raised toxicology concerns because animal studies have produced certain tumor findings, and researchers have studied mechanisms through which hydroquinone and related metabolites could potentially cause cellular damage. However, translating those findings directly into a claim that topical hydroquinone causes cancer in people would go beyond the evidence currently available. (PubMed)
One review of decades of medical hydroquinone use reported no documented human malignancy attributable to the drug, while other researchers have continued to argue that potential long-term risks deserve consideration. (PubMed)
So this is an area where I believe consumers deserve context rather than fear.
The question should not simply be, “Is hydroquinone dangerous?”
It should be, “What am I using, why am I using it, at what concentration, for how long and who is monitoring my skin?”
And What About Arthritis?
There has also been research examining hydroquinone exposure and rheumatoid arthritis.
But this finding needs to be interpreted carefully.
One study found that inhaled hydroquinone exposure worsened symptoms in a rat model of rheumatoid arthritis. The research was investigating hydroquinone as a component associated with cigarette-smoke exposure, not studying typical topical hydroquinone treatment for hyperpigmentation in human patients. (PubMed)
That distinction matters.
A finding involving laboratory animals and inhaled exposure should not automatically be interpreted to mean that a person applying prescription hydroquinone to the skin will experience worsening arthritis.
Your Dark Spots Deserve a Diagnosis, Not Just a Lightening Cream
This may be the most important part of the conversation.
If you have discoloration, first ask why it is there.
Is it post-inflammatory hyperpigmentation left behind after acne?
Melasma?
Irritation?
Sun exposure?
A reaction to another product?
Something else entirely?
Treating pigmentation without understanding what is causing it can turn skincare into an exhausting cycle of lightening, irritating, darkening and trying another product.
A qualified skincare professional can help you understand what may be happening with the surface of your skin, while a dermatologist or other appropriate healthcare provider can diagnose and medically treat conditions that require medical care.
Hydroquinone can have a legitimate role in treating hyperpigmentation. But legitimate use is very different from indiscriminate skin bleaching or prolonged, unsupervised use.
Lightening Is Not the Same as Caring for Your Skin
For Black consumers especially, I think we should be able to have a more thoughtful conversation about pigmentation.
Wanting to improve an acne mark or uneven pigmentation is not the same thing as believing that darker skin itself needs to be corrected.
And healthy skin should never require us to damage our skin in pursuit of a lighter complexion.
Know what is in your products.
Know why you are using it.
And when an ingredient crosses from cosmetic skincare into medication, let that be a signal to involve an appropriately qualified professional.
Your goal should not simply be lighter skin.
It should be healthier skin.
Questions
When you see a product promising to fade dark spots quickly, what makes you trust it enough to put it on your skin?
Were you aware that hydroquinone is no longer legally sold as an over-the-counter skin-lightening drug in the United States?
About Katina Gilmore
Katina M. Gilmore, RN, LE, is a Licensed Esthetician, registered nurse and esthetics instructor with more than a decade of experience and a particular focus on Afro-ethnic skin.
Before becoming a licensed skincare professional, Katina began as a self-taught botanical cosmetic formulator. Building on her background in health education, she went on to earn her Esthetician license, registered nursing license and esthetics instructor license in Texas within a five-year period.
As a registered nurse, Katina has trained and worked in aesthetic dermatology services including medical laser hair removal, body contouring and cosmetic injectables, and has also completed training in electrolysis hair removal.
In 2016, she founded The Black Estheticians & Skin Therapists Association, or The B.E.S.T. Association, as a space for Black skincare professionals to connect, share their experiences and challenge one another to “level up.”
She is also the founder of The Skin Health Coach and The COCO Pod Skincare and has served as a faculty speaker at the Nuekie Skin of Color Conference.
Katina describes herself as a CEO: Confident Esthetics Operator.
