Questions like “Why was hydroquinone banned in the E.U.?” “Can hydroquinone cause hyperpigmentation?” and “Does hydroquinone bleach your skin?” come up often in social media chatter.
Truth is, hydroquinone is proven to be a highly effective topical treatment when used correctly. But there have been misconceptions about its side effects. As with any prescription product, you have to use hydroquinone as directed to get the best results. And you need to give it time to work its magic.
To clarify just what hydroquinone can and cannot do, we enlisted Michael Krathen, M.D., a board-certified dermatologist in Natick, Massachusetts, and Chief Medical Advisor for Cottonball, to separate the myths from the facts—and explain how this gold-standard remedy can benefit your skin.
What is hydroquinone, and how does it work?
Hydroquinone has been on the skincare circuit for more than 85 years. Discovered in the early 1800s, scientists learned in the 1940s that this chemical compound inhibits tyrosinase, a key enzyme in controlling skin’s production of melanin.
By intercepting this process, hydroquinone can effectively lighten dark spots and blotches to even out skin tone, though it’s not an overnight fix. Visible results can take a month or longer, because hydroquinone works at the cellular level to slow down pigment production. As the skin sheds darker cells to allow fresh cells to rise to the surface, your skin will gradually become more even toned.
“Hydroquinone is the go-to ingredient for reducing pigment production,” explains Dr. Krathen. “It treats melasma, sunspots, and post-inflammatory hyperpigmentation [dark spots left by acne or an injury to the skin].” He adds that dermatologists often prescribe hydroquinone in conjunction with a retinoid to optimize results, as the retinoid helps improve the penetration of hydroquinone while also increasing skin cell turnover to shed the darker cells.
One study found that participants who used a treatment of 4% hydroquinone in conjunction with 1% retinol saw s
ignificant improvement in mild to moderate melasma within 4 weeks, with up to 75% improvement in melasma severity by the end of the 24-week study.
Cottonball CX.1 Advanced Dark Spot Treatment combines a customized dose of hydroquinone with the retinoid tretinoin—both in prescription-strength concentrations—to deliver maximum spot-fading benefits.
How do you use hydroquinone?
Hydroquinone is a targeted, short-term, nighttime treatment. As of 2020, the ingredient is available only via prescription in the United States.
When using Cottonball CX.1 Advanced Dark Spot Treatment, apply it only where you have spots or discoloration. It’s best to ease into the treatment by using it for two to three nights for the first few weeks, gradually increasing to nightly use as tolerated.
Don’t Hide It. Fade It. Our dark spot Rx is clinically proven.
The CX.1 cream should be applied at night for 8 consecutive weeks (in general, you should never use a product with hydroquinone for more than 12 consecutive weeks to avoid potential side effects). If you still have pigmentation issues, you can resume use of CX.1 after 12 full weeks of not using the product to give your skin a break in between treatment cycles.
Once you’ve completed your hydroquinone treatment, we recommend transitioning to Cottonball VX.4 Daily Skin-Brightening Formula, “a hydroquinone-free formula with a lower dose of tretinoin to maintain even-toned skin and prevent new discoloration and dark spots from forming,” says Dr. Krathen.
What are the potential side effects of hydroquinone?
Hydroquinone can cause mild stinging, itching, and redness, particularly on sensitive skin, which is why you want to ease into using the treatment. If you apply hydroquinone as directed, your risk of developing side effects is quite low. But when people misuse the treatment, issues can arise.
Hydroquinone requires precise application in a thin layer. Using too much or putting it on skin outside the borders of a dark spot will lighten the natural-tone skin, too. This is known as the “halo effect,” when the skin around a dark spot becomes lighter than your natural skin tone, leaving what looks like a light-colored halo ring around the treated area. But if this happens, the halo will fade once you stop using hydroquinone.
Another potential side effect of misusing hydroquinone is ochronosis, a counterintuitive condition where the treated skin becomes darker rather than lighter. Ochronosis can occur if you use hydroquinone for longer than directed or in a concentration that’s too strong for your skin. This is why it’s important to do the treatment under the supervision of a board-certified dermatologist.
At Cottonball, our entire range of prescription skincare is customized to your complexion needs and reviewed by a dermatologist. This ensures you’re getting the correct formulations for your skin.
What are the most important things to know about hydroquinone?
There are some lingering misconceptions around hydroquinone, so let’s set the record straight.
Myth #1: Hydroquinone can’t be used on darker skin tones
The truth: Hydroquinone is suitable for all skin tones and types, including darker skin. However, since dark skin contains more melanin, pigmentation issues can run a bit deeper than they do in fairer skin tones and may require a stronger concentration of hydroquinone.
This is why it’s important to use the treatment exactly as directed to avoid any potential side effects. There is a slightly higher risk of developing ochronosis in deeper skin tones, so stick with your prescribed concentration and use it only for the advised length of time.
Myth #2: Hydroquinone bleaches the skin
The truth: This is where language matters, because the concept of “skin bleaching” or “skin whitening” is a sensitive subject in some cultural communities.
Hydroquinone is designed to even out your natural skin tone, not to lighten it. It works by inhibiting tyrosinase to reduce overproduction of melanin. It doesn’t lift color from the skin. Rather, it slows new pigment formation and allows areas of discoloration to fade naturally through the skin’s cell turnover process.
Dermatologists consider hydroquinone a skin tone blender, not a whitener. Again, when used as directed, it evens out skin tone without altering your natural complexion.
However, it is important not to layer hydroquinone with benzoyl peroxide, hydrogen peroxide, or any other peroxide products. Doing so can stain the skin a blue-gray tone or cause causes irritation and dryness.
And remember that hydroquinone is a targeted treatment. It’s not meant to be slathered all over your face. Apply it only on dark spots or areas of discoloration.
Myth #3: You can use hydroquinone for as long as you like
The truth: It bears repeating that you run the risk of developing ochronosis if you use hydroquinone for longer than directed. In this case, more is not more, so stay within the timeline of this short-term treatment.
As a reminder, Cottonball CX.1 Advanced Dark Spot Treatment can be used for 8 consecutive weeks. And no matter the formula, never use hydroquinone for more than 12 consecutive weeks.
With consistent use, hydroquinone typically begins to fade hyperpigmentation within 4 to 6 weeks. If you reach your desired level of skin tone correction before 8 weeks, stop the treatment. If needed, hydroquinone can be resumed after a 12-week break.
Once you’ve completed your course of hydroquinone, help prevent dark spots or melasma from returning with a nightly cream that increases skin turnover (such as the tretinoin-infused Cottonball VX.4 Daily Skin-Brightening Formula) and a daytime moisturizer or sunscreen with broad-spectrum SPF 30 or higher.
If you’re prone to melasma, even a small amount of unprotected sun exposure can immediately bring it back. Protection equals prevention, so wear sunscreen every day, year-round.
Myth #4: Hydroquinone is linked to cancer
The truth: This is arguably the most misunderstood concern about the treatment, bolstered by the bevy of misinformation that circulates online and on social media.
Allow us to clarify: There is no clinical evidence that hydroquinone causes cancer in humans when applied topically in a cream for short-term use. And the ingredient’s safety in personal care products has been studied for more than 60 years.
The issue gained attention in 2001, when cosmetic use of hydroquinone was banned in Europe (and still is to this day) out of concern over its potential side effects like ochronosis due to unmonitored use. When a study around the same time on lab rodents found evidence of carcinogenicity when the animals ingested hydroquinone orally, it became entwined with the European ban, leading people to believe that the ban was based on the rodent study, which it was not.
Since then, counter studies have shown that the rodent lab experiment was conducted on rats predisposed to develop the specific type of cancer tumors mentioned in the study, which humans do not develop. In addition, a study that tracked around 900 workers in a hydroquinone-manufacturing facility over a 50-year period found that they actually had lower rates of cancer than the general public.
The U.S. Food and Drug Administration (FDA) continues to keep hydroquinone available by prescription in the United States, citing lack of clear evidence that it poses a risk to humans when applied topically for short-term use. Dermatologists continue to stand by the treatment, often noting that you’d have to slather yourself head to toe in hydroquinone every day for a long while before your body would absorb enough of the ingredient to potentially pose a health risk.
With decades of clinical research behind it, hydroquinone remains one of the most effective, dermatologist-backed solutions for fading stubborn spots and discoloration, helping restore skin to its bright, radiant best.
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