Through the height of the COVID-19 pandemic, the US Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act to supply economic assistance for American employees, small businesses, and industries. It also included a provision banning the sales of over-the-counter hydroquinone.
Very similar to a Russian nesting doll, major laws passed in Washington is commonly full of smaller, less-publicized provisions. As an alternative of voting on each item individually, lawmakers can bundle multiple issues right into a single piece of laws.
For a long time, dermatologists have referred to hydroquinone because the ‘gold standard’ on the subject of treating hyperpigmentation—which is more common on Black skin—including skin conditions like melasma. And studies have shown that when used under the supervision of a board-certified dermatologist, hydroquinone is simpler than other topical ingredients when treating hyperpigmentation.
So why was over-the-counter hydroquinone banned in the US? “Hydroquinone was faraway from OTC products consequently of concerns over safety and hostile effects,” explains Dr. Ryan Turner, board-certified dermatologist and co-founder of TRNR Skin.
The ingredient has a foul status, partly as a consequence of its presence in a sturdy, unregulated black market, in addition to bans within the European Union. Ahead, I spoke with experts to uncover whether hydroquinone deserves the villain treatment it has received or if the reality concerning the ingredient is more complicated than meets the attention.
What’s hydroquinone?
“Hydroquinone is a skin-lightening agent that might be used to treat dark spots and patches, corresponding to hyperpigmentation, sun spots, melasma, and post-inflammatory hyperpigmentation,” explains Dr. Turner. “It’s also a potent antioxidant.” Hydroquinone works by blocking tyrosinase, an enzyme that “converts the amino acid tyrosine into the precursors needed to supply melanin,” adds Dr. Turner. By inhibiting tyrosinase, hydroquinone reduces melanin production and helps lighten areas of hyperpigmentation. It’s one of the crucial potent skin-lightening agents available.
With great power comes great responsibility. Under medical supervision, hydroquinone treatments are applied a couple of times each day for up to 3 months. “Depending on what’s being treated and the response after three months or so, a dermatologist will typically swap out your hydroquinone for a unique skin-lightening topical,” says Dr. Turner, “cycling it back in as needed.”
What are the unwanted effects of using hydroquinone?
Hydroquinone’s potential unwanted effects come into play when it’s overused or used without medical supervision. Allergic response, redness, irritation, and hypopigmentation are all potential unwanted effects, explains Dr. Turner. “There’s also a more worrisome side effect of hydroquinone use generally known as exogenous ochronosis,” he adds. Exogenous ochronosis is a kind of skin coloration where the skin darkens and thickens, often turning a blue-black or gray-black color. This happens when homogentisic acid builds up within the skin, says Dr. Turner.
Exogenous ochronosis is a rare skin condition that may occur while you use certain products, like hydroquinone, for a very long time. It’s a kind of skin discoloration where the skin becomes darkened and thickened, often turning a bluish or grayish color. This happens since the skin starts to accumulate a substance called pigment in an unusual way, which might be caused through the use of an excessive amount of of some chemicals over time. “Again, because of this it’s so vital to only use hydroquinone under the supervision of a dermatologist,” adds Dr. Turner.
How is hydroquinone utilized in other parts of the world?
Outside the U.S., there have been reports of unregulated hydroquinone products with higher concentrations, often combined with mercury and steroids, explains Dr. Ryan. “Nonetheless, the risks related to hydroquinone are primarily as a consequence of misuse, overuse, or contamination of products.”
These potential risks are why Dr. Grace Ayensu-Danquah, an American-trained general surgeon and Borghese Skin Expert, doesn’t recommend hydroquinone to her patients. “In Africa and Asia, hydroquinone is commonly used to brighten or lighten the skin,” says Dr. Ayensu-Danquah, who relies in Accra. Before the ban within the U.S., hydroquinone was in the stores in a 2% concentration. In regions where skin bleaching is prevalent, bleaching creams are sometimes formulated with very high concentrations of hydroquinone, corresponding to 8% or 10%. “It became the chemical of selection since it was cheaper than other skin-brightening ingredients,” she explains.”While you visit markets in Africa, you’ll often see women with large purple or black blotches on their faces. They’re buying unregulated creams and lotions containing hydroquinone and applying them each day for years.”
Hydroquinone also increases the skin’s sensitivity to the sun. Limiting sun exposure and following strict sun protection protocols are crucial for treating and stopping future hyperpigmentation, says Dr. Turner. Nonetheless, maintaining these precautions might be difficult within the tropical climate of West Africa. The increased sensitivity to the sun and the intense unwanted effects that come together with the indisputable fact that hydroquinone products aren’t regulated in Ghana is why Dr. Ayensu-Danquah tells her patients to remain away. “It does have a spot when treating hyperpigmentation or melasma, but there must be strict medical advice and supervision.” As an alternative, Dr. Ayensu-Danquah typically recommends vitamin C to her patients as a safer, over-the-counter alternative to hydroquinone.
Why is hydroquinone banned within the EU?
The EU follows the “precautionary principle,” meaning that even when there’s uncertainty concerning the potential risks of a chemical or ingredient, the governing body will restrict or ban its use until further research confirms its safety. There was ongoing debate, particularly online, about whether hydroquinone poses a cancer risk.
Some evidence suggests that when taken orally, hydroquinone may cause kidney cancer and leukemia in rats. Nonetheless, no link has been found between hydroquinone use and cancer in humans. Despite this, the EU determined that the potential for misuse, combined with safety concerns, outweighed the advantages of creating hydroquinone widely available. The U.S. Food and Drug Administration (FDA) has not determined that hydroquinone poses a cancer risk to humans when used topically at appropriate concentrations.
The Final Word
While the ban on hydroquinone in OTC products has led many individuals to consider it’s dangerous, Dr. Turner explains, “The risks related to hydroquinone are largely as a consequence of misuse, overuse, or contaminated products.” Many regulated ingredients in OTC skincare that may have negative unwanted effects if misused or overused. Once more, it’s all about moderation and medical supervision. “Hydroquinone is a really useful and useful skincare tool when used accurately.”
