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Dark spots, hyperpigmentation, and acne scars are three of the peskiest skin issues we experience. The right skincare products are the first defense—a good exfoliant, a brightening cream, and a vitamin C serum, for starters. However, even with all of the best products in the world, it's possible a particularly stubborn spot will stick around. That's when some people look to other remedies, like hydroquinone.
According to cosmetic and plastic surgeon David Shafer, MD, FACS, "Hydroquinone is a chemical compound discovered in the early 1800s [and] was used in everything from skin care to photo developing. The chemical interacts with the melanin-producing cells in the skin, decreasing the production of pigment." While it can be effective at lightening dark spots on the skin, there has been some debate about its safety.
Meet the Expert
David Shafer, MD, FACS is a double board-certified cosmetic and plastic surgeon at Shafer Plastic Surgery in Manhattan, NY. Shafer's world-renowned for his innovative techniques and personable bedside manner have won him countless awards such as the Harry W. Hale Jr. Surgery Award for Outstanding Surgeon.
Keep reading to see what the expert has to say.
What Is Hydroquinone?
Also known as tocopheryl acetate, hydroquinone is found in skin-lightening creams, cleansers, and moisturizers. "Hydroquinone is a topical skin treatment for melasma, freckles, age and sun spots, and even acne scars," Shafer says. "Used in combination with other acne products such as Retin-A, hydroquinone can help dramatically improve skin complexion."
That doesn't mean the results are permanent, though. In fact, Shafer says it's quite the opposite. "The effect is temporary, as discontinued use and exposure to the sun can lead to renewed production of pigment and the return of dark spots."
The effect also isn't immediate. It may take a matter of weeks, even months, before results are discernible to the naked eye. "Patients need to understand that the treatment is working at the cellular level to reduce the production of pigment," Shafer says. "So the effects take several weeks to realize. As the old skin sheds and new skin is produced, the amount of pigment will be less, leading to a more even skin tone."
Over-the-counter hydroquinone products are available at concentrations up to 2 percent. Anything higher than that requires a prescription, and for good reason.
You may have heard some questionable things about hydroquinone. It's been banned in the UK, Europe, Japan, and Australia. The truth is, even though it has been shown to effectively lighten dark spots, something this potent is not without risks. It's classified by the Environmental Working Group as a skin toxicant and allergen.
It also can cause "halo spots" around the treated areas. "The hydroquinone treats dark spots, but any product in contact with surrounding skin will also lighten those areas as well. So the intended spot may be lightened, but the surrounding skin will also lighten compared to normal skin, and the area will appear like a light depigmented halo around the spot being treated," Shafer says.
If you do choose to use hydroquinone, there is a way to avoid this. Shafer recommends lightly applying a hydroquinone solution to a region or area, versus a single dark spot or acne scar. But some might say that defeats the purpose of using it as a spot treatment.
Another potential side effect that may negate hydroquinone's efficacy is that with long-term use, it could potentially cause ochronosis—ironically, discoloration of the skin—particularly in those with darker skin. For many, this risk alone makes the ingredient not even worth trying.
The biggest, most substantial issue with hydroquinone is that it hasn't been ruled out as carcinogenic by the FDA. "It was found to increase the incidence of neoplasms in rats," Shafer says. "However, the risk to humans is unknown." Because of the rather dubious research, Shafer recommends looking elsewhere for dark-spot relief. "There are other skin-lightening and skin-brightening products available with fewer side effects," he says.
Shafer's favorite alternatives are two separate skin tone–correcting products: SkinMedica Lytera 2.0 ($154) and Sénte Dermal Repair Cream (you'll need to find an authorized medical practitioner or medical spa that carries the latter). "Both products have components which also interfere with pigment production but without the skin irritation or sensitivity," Shafer says. "Clinical studies show that Lytera 2.0 is just as effective as hydroquinone. Both Lytera and Dermal Repair from Sénte are available at doctors' offices as part of a continuing skincare regimen."
Although less potent, natural alternatives can still be powerful enough to brighten up your complexion overall, including dark spots. Look for products that feature kojic acid, licorice root, papaya enzyme, or vitamin C.
How to Use Hydroquinone Products Safely
If you do decide to incorporate hydroquinone into your regimen, it's definitely best to consult a dermatologist or a physician first. For optimal results, they may recommend combining it with other milder brightening and exfoliating ingredients like retinol, or lactic, glycolic, or salicylic acid. It's important that they keep watch on you and your skin throughout the process. After several weeks, they may advise you to take a break from the product.
You should also be vigilant about wearing sunscreen every day, rain or shine, when you use hydroquinone, as UV rays can exacerbate the spots you're trying to get rid of. Clearly, hydroquinone is no joke. Be safe out there.