Skin whitening is still a prevalent cosmetic practice in the U.S. and many other countries around the world. The dangers of bleaching solutions that contain mercury have been well publicized. However, this still leaves many products on the market that contain other agents for lightening pigmentation. Many are marketed to fair skinned individuals as formulas for rejuvenating skin and reducing the appearance of age spots. The same ingredients are used in whitening creams marketed to darker skinned groups for all over lightening. In some cases, these solutions may contain a higher percentage of active ingredient(s) making them tougher on the skin and increasing the risk of side effects.
HQ Among the Most Popular Ingredients
Hydroquinone (HQ) is an example of a whitener that is available both over the counter and in prescription strength concentrations. It is also often combined with other substances such as vitamin A compounds (retinoids) or glycolic acid (typically used in light chemical peels). HQ is prescribed by many dermatologists to treat dark blotches on the skin. Typically, dermatologists will recommend this treatment when a patient has hyperpigmentation from scarring or a medical condition such as melasma or age spots that have caused darkening of a specific area of the skin. It is not really designed to act as a skin whitening agent for patients who want to achieve a noticeably paler overall skin tone.
Skin Irritation is an Expected Side Effect
Although this medication is frequently prescribed by doctors and currently available in OTC form, this does not mean the solution has no side effects. In fact, depending on the concentration and whether HQ is mixed with other active ingredients, a high percentage of patients experience irritation when using this type of cream. Reporting on the exact numbers vary from one study to the next. Not all patients follow up to report adverse effects. Plus, those using OTC versions may not be under the care of a dermatologist who would monitor their reaction. However, at the extreme upper end of the scale, estimates for irritant reactions range from 70-100% of patients. These symptoms usually resolve when treatment is discontinued.
The most serious, long-term side effects appear to occur in patients with dark skin who use HQ primarily as a skin whitening treatment for extended periods of time. Ochronosis (which causes various types of discoloration and the growth of nodules on the skin) is the most commonly reported chronic side effect of skin whitening. It can be experienced even by those who use the milder 2% HQ formulas. This complication is rarely reported in the U.S.
FDA Not Pleased with OTC Availability for this Drug
Currently, the FDA is considering banning over the counter HQ products (a step the EU has already taken) and requiring drug companies to resubmit prescription formulations through a stricter approval process. This ban was first proposed in 2006. It has still not been implemented and might never actually be finalized. For now, patients can best ensure their health and safety by consulting with a dermatologist and using hydroquinone products only as directed.