Hydroquinone: Is it the best topical treatment for hyperpigmentation?

What is hydroquinone?

This can be referred to as an aromatic organic compound derived from benzene and also referred to as benzene-1,4-diol or quinol and is a type of phenol.  This compound is extensively used as a skin-bleaching agent for hyperpigmented skins and is available as over-the-counter 2% cream.  Due to its popularity, there are several products such as lotions, creams, emulsions, gels, and solutions available with hydroquinone present in it.  The compound is popular as a photo developer which can lighten hyperpigmented skins.

The benefits of this compound are reversible when exposed to sunlight and hence a long-term use is necessary to obtain desired results.  This compound is helpful in reducing the symptoms of several skin conditions such as freckles, acne scars, melasma, and age spots.  Creams containing hydroquinone is used along with sunscreens to prevent reversing of its effects.  Skin lightening can be noticed within 4 weeks of regular use.

Mechanism of action

Hydroquinone interferes with melanin production ultimately decreasing the production of melanin from melanocytes.  This is done by decreasing the conversion of tyrosine to DOPA and achieving reduced pigment levels.  Since a lesser number of melanocytes is produced, it naturally reduces melanin production resulting in lighter skin.

What Is Hyperpigmentation?

Darkening of the skin due to high melanin levels is called hyperpigmentation.  This is considered to be one of the most common skin problems among both men and women, which worsens with age.  Due to increased melanin production, certain areas of the skin may have a change in color such as red, pink, brown, and purple.  These pigmented areas become more noticeable when exposed to sun and can occur in both the epidermis layer and deeper dermis layer.  Minor discolorations caused by acne scars or freckles generally fade out whereas hyperpigmented areas require extensive treatments to fade out.

Causes of hyperpigmentation

Hyperpigmentation may be caused due to several factors whereas metabolic and medication causes are two important factors that stand out.  Causes of hyperpigmentation should be assessed on the basis of medical history, onset, and the duration of symptoms.  Deficiencies of vitamin B12 and folic acid are considered the metabolic cause of hyperpigmentation.  Since medication too can cause pigmentation, medication history needs to be obtained and the offending agent needs to be discontinued.  Overall the most common causes include:

• High sun exposure: Ultraviolet radiation from sunlight weakens collagen fibers in the skin by creating free radicals.  This leads to the alteration of DNA by limiting skin repair by stem cells.  Alteration of DNA can lead to skin cancer in certain cases.  Melanin is produced in the skin to protect the skin against ultraviolet rays.  The production of melanin increases with sunlight exposure leading to discoloration of the skin.  Regular exposure to ultraviolet radiation does not give enough time to the skin to produce sufficient melanin in the skin and leads to red spots or sunburn.
• Acne caused due to hormonal imbalance and other factors can cause red, brown, and purple spots on the skin called scarring.
• Contact dermatitis, psoriasis, and eczema cause skin damage and lead to discoloration.
• Hormonal imbalances during menopause and pregnancy can cause skin damage.
• Autoimmune diseases, metabolic disorders, vitamin, and folic acid deficiencies, as well as inflammation of the blood vessels, play an important role in causing pigmentation of the skin.
• Tobacco and alcohol use may lead to aging and skin discoloration.
• Side effects from medications that increase photosensitivity can lead to skin pigmentation.
• An unhealthy diet that is malnourished and rich in chemical additives lead to damage of the skin resulting in discoloration and pigmentation of the skin.
• Damage caused to the skin from shaving, waxing, tattooing, cuts, and scrapes.
• Genetics too play an important role.
• Finally, aging leads to hyperpigmentation of the skin.

Signs & Symptoms of Hyperpigmentation

There are three main types of hyperpigmentation that occur due to various factors.  Each type causes different symptoms and few can be easy to treat whereas others may require extensive treatments.  Some of the most common signs and symptoms include:

• Sunspots:  Discoloration and pigmentation caused by exposure to sunlight are the most common skin condition people develop.  This discoloration may affect a person as early as teens and extends into the twenties.  Sunspots generally develop on areas such as face, chest, neck, and hands since these are the areas that are exposed to regular sunlight.  These are flat spots that become darker with sun exposure.  Another type of sunspot is the freckles which affect light skin colored people.  They appear as small dots of brown, black, and even red spots.  Freckles generally affect the face and become darker with sun exposure.  They also occur on the chest, back, arms, etc.
• Post-inflammatory hyperpigmentation (PIH): PIH is caused due to an underlying health condition.  It can occur from hormonal problems, disorders, or illnesses such as acne, psoriasis, eczema, and dermatitis.  Hyperpigmented areas may have bright colored spots which might be black, red, and brown.  Studies have found that PIH mainly affects dark skin, but can affect any skin tone.
• Melasma: Hormonal changes result in this condition.  A brownish discoloration occurs mainly on the face and increases with skin exposure.  Many women experience this during pregnancy.  They may resolve on their own when the hormones become more balanced.

Conventional Treatments for Hyperpigmentation

Hyperpigmentation can be treated with over-the-counter products or by visiting a dermatologist for more intensive treatments.  Several topical care products are available in the market in the form of creams, lotions, serums, etc that can lighten the skin.  Following are the treatments for hyperpigmentation:

• Hydroquinone: This is an aromatic compound used to reduce dark spots and discoloration.  A 2% concentrated creams and lotions are available in the market which can be bought over-the-counter.  Regular use of this compound containing cream with sunscreen can produce the desired output.  Pregnant women should abstain from using creams and lotions containing this compound as they may give side effects.
• Depigmentation peel can be used to treat skin conditions like melasma.
• Chemical peels can be used which contain salicylic or glycolic acid.
• Retin-A can be used in serum or extract form for removing pigmentation and is considered the dermatology’s gold standard treatment.

Hyperpigmentation treatments performed by a dermatologist include:

• Microdermabrasion: This is a procedure where the superficial layer of the skin is removed, which lightens dark spots.
• Hyperpigmentation laser treatments are used to remove the discoloration from deep beneath the skin. This treatment is considered to be highly effective but the downside of this treatment is due to the high costs associated with it.  Milder laser treatments work fine for the majority of the patients, but the intense treatment may cause redness and irritation of the skin and is not tolerated by all.

Natural Ways to reduce Hyperpigmentation

Limit Sun Exposure:

Sunlight is a boon to us when we have limited exposure.  This is necessary to produce vitamin D.  However, the same sunlight can become a bane and cause free radicals when we have increased exposure.  This can cause oxidative stress and lead to cancer formation.  A 20 minutes exposure to sunlight is considered perfect.  Dermatologists also recommend avoiding sunlight exposure during peak hours from 10 a.m. to 3 p.m.  It is believed that sunlight contains the maximum concentration of ultraviolet radiation during this period.  Protective measures should be taken to avoid direct exposure of sunlight on the skin if you are already suffering from hyperpigmentation.  On the other hand, if you are still not affected, you need to make sure to keep the sunlight exposure to a limit.

Consume an anti-inflammatory diet

Discoloration and photoaging of the skin are caused due to malnourishment.  Diet low on vitamins and minerals can cause early pigmentation, dryness, as well as sagginess of the skin.  Anti-inflammatory foods are known to reduce free radicals and limit the process of oxidative stress.  These foods are known to fight against skin cancer by reducing inflammation.  Some of the foods that help in this process include berries, green leafy vegetables, omega-3 rich foods, and antioxidant-containing foods such as blueberries, strawberries, cherries, and pomegranates.

Other healthy foods include tomatoes, which works as natural protection against sunburn.  Carrots, sweet potatoes, and green tea contain polyphenols that reduce inflammation.  Coconut oil, olive oil, almonds, and avocados contain healthy fats that help in reducing inflammation.  Since collagen plays an important role in maintaining structure and strength to the skin, it is important to increase collagen levels.  This can be achieved by consuming bone broth.

Use natural skin care ingredients

Switching from chemical skin care products to natural skin care ingredients would be a smart choice.  A natural skin scrub such as sugar scrub can be used to exfoliate dead skin from the surface of the skin.  Similarly, natural moisturizers such as coconut oil or lavender oil can be used to moisten the skin.  Some of the other natural skin care ingredients are discussed below:

• Licorice root: Licorice root extract is known for its skin lightening effect.  This is achieved by reducing melanin production in the skin.  The licorice root extract is available in creams and lotions at 0.5 to 1% concentration.  They reduce symptoms associated with melasma, eczema, skin inflammation, etc.
• Retinoids: Dark spots and sun damage caused to the skin can be reduced with retinoids.  It is considered to be one of the most popular skin care products.  Retin-A would require a prescription from your doctor, but other over-the-counter products are also available.
• L-ascorbic acid: This is another popular skin care product that can treat acne spots and scars.  This is available as a cream or serum with 10 to 15 percent concentration.  These products are generally used while going to bed and left overnight.

How to use hydroquinone?

Now that we know what is hyperpigmentation and how it can be treated with the use of hydroquinone, let us discuss how this compound can be used to relieve the symptoms of hyperpigmentation.  It is important to read the instructions on the label and perform a patch test to determine if you are allergic to this product.  Apply a small amount of this product to any part of the skin such as the forearm.

Next, cover the area with a bandage and wash your hands to prevent exposure to other areas of skin.  Analyze the area after 24 hours.  Discontinue the product if any reaction is found.  On the other hand, if no reaction is found, you can use this product to the pigmented area.  Apply a small amount of the cream to the skin and massage it so that the cream seeps inside the skin.  You need to apply sunscreen along with this product.  Sunlight can reverse the effects of hydroquinone and hence sunscreen is needed to avoid this.

You should use this product consistently, but not overuse it.  A regular application for three months should provide the desired results.  If no change is found after three months of application, you need to contact your dermatologist for an alternative.

Side effects of hydroquinone

Hydroquinone is considered highly safe and hardly causes any side effects.  People with sensitive skin may experience minor skin irritation, but this should be excluded by performing a patch test before using the product.  A case of ochronosis has also been reported due to extended use where bluish pigmentation with papules may occur.  This may be caused if it is used continuously for more than five months.

References

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