Hydroquinone For Hyperpigmentation: Is eyelids

All that you need to know about its topical use.

Let's start with melanin's role!

Melanin is a vital component of skin. You must have heard it everywhere. It absorbs the harmful UV rays of the sun, shielding your skin.

But sometimes, melanin makes a mess. The pigment, which gives your skin its unique complexion, can increase its production and herd together in a mass at specific spots on your body. Camping out, and in a pretty obstinate way! It can result in dark patches and spots, black or brown, forming mostly on the face, shoulders, arms and legs. What do you call this mess? Hyperpigmentation, or at least what the skincare experts term it as.

A little accumulation of melanin at specific places on your skin is nothing serious. However, in some cases, it may indicate any underlying health complication.

There are many ways to get rid of these spots. Natural as well as synthetic means; the latter shows quicker results, though. 

How about Hydroquinone? 

Hydroquinone, undoubtedly stands foremost in the line of skin-lightening ingredients of chemical origin, if we have to pick one based on efficacy. However, this bleaching agent remains surrounded by rumors, myths, and ambiguity- an agreeable reason why a lot of people dread to include it in their skincare routines.

The fact that it is banned in Japan, Australia, UK and Europe, adds to its dread factor. Yet, in the US, one can avail hydroquinone in the pre-formulated combinations. Their sales tightly bound by a rigorous set of rules, with only a 2% strength of it available over the counter and a 4% with a definite prescription.

India has had no such restrictions on the use of hydroquinone until the last year. But following a recommendation by the DTAB (the country's highest drug advisory body on technical matters), there has been a ban imposed on the OTC sales of hydroquinone from April 1, 2019.

It is also included under the 'scheduled H-drugs' category, which implies that it can be purchased only if you have an authentic prescription, duly signed by a dermatologist.

"Many reasons have led to this ban. Take the common people, for instance. They use the ointments, including hydroquinone, for unchecked periods, almost blindly. Unaware that it can lead to skin grievances. The companies try to mix in heavy concentrations of hydroquinone or several other toxic ingredients along with it in the products they prepare. All happens because the ingredient is not strictly regulated in the market," cautions Dr. Mukesh Girdhar, Vice President, IADVL.

"Even some of the dermatologists compromise their ethics, and prescribe high doses of the ingredient to their patients, not worrying about the results. Rash, irritation, and sometimes, extreme discoloration of the skin may occur, effects of which are practically irreversible."

Despite dragged into a loop of claims, it remains the backbone of endless skin-lightening treatments. Because of its robotic mechanism, it continues to provide a huge cosmetic motivation in skincare. 

What are the leading causes of hyperpigmentation? 

1) Prolonged exposure to sunlight 

Going unwarranted in the heat, without sunscreen or protective clothing, can bring flat brown tans on the face and scalp. More common in people with fair skin and those above the age of forty. 

Minimalist Note:

When the skin is exposed to strong sunlight suddenly, sunburns develop in its topmost layers. Yet, they can be treated easily and usually clears off in a couple of weeks. 

Sunspots are, however, due to repeated outings in the sun. It is formed in the deeper layers of the skin. It can be challenging to treat the stiff spots, and the process may extend over to several months.

2) Hormonal changes in the body 

Birth control pills induce shifts in the hormone levels and can lead to brown or grey-brown patches appearing on the forehead, nose, cheeks and chin. You term the condition as melasma. Pregnancy, on the whole, is quite a stressful phase, causing hormonal imbalance in many women.  

3) Medications

A few medications increase your skin's sensitivity to the sun. Also, chemotherapy drugs can cause hyperpigmentation as a side-effect. 

4) Post-inflammatory hyperpigmentation (PIH) 

Skin trauma in the form of wounds, cuts, bruises, first-degree burns, pimples, nodules, and other forms of acne can pave the way for inflammation. They all leave behind scars and patches, wherein the melanin increases and gathers, leading to PIH.

Due to aging, the skin gets rougher and fragile, becoming more prone to bruises. 

5) Symptoms of diseases 

Liver diseases may cause the darkening of the skin.
.
Addison's disease, a rare endocrine malfunction, triggers hyperpigmentation in areas that go uncovered in the sun, i.e., face, neck and hands. Also, areas worn out due to friction, such as elbows and knees. 

A little something about the dark pops and patches on your skin. 

UV A and UV B rays of the sun increase melanin's production, and less commonly, the number of melanocytes (the cells forming melanin, located at the junction of epidermis and dermis.)

This also fuels the transfer of melanosomes (container-like structures inside your melanocytes, in which tyrosine is converted to melanin) to the keratinocytes (skin cells), and which are further pushed to the epidermal surface.

As a result, some areas of skin form odd patches which appear darker than the surrounding regions. 

Now, what does hydroquinone exactly do?

• It causes the reversible inhibition of tyrosinase, the key enzyme that leads to the conversion of tyrosine to melanin. 
  
• Selective damage met out to the melanosomes and melanocytes. Its primary mechanism is to prevent the formation of melanin. 
  
• With the monthly turn-over of the epidermal keratinocytes, the melanin-containing older ones shed away. New keratinocytes with less-pigmented melanosomes are formed. 
  

David Shafer, a cosmetic and plastic surgeon., Says:

It is hydroquinone putting a stop on the melanin formation throughout the process. And meanwhile, we wait for the old skin cells contributing to the spots to shed off naturally. That's why it takes time for hydroquinone to show results. At least two months or so

Hydroquinone effectively lightens the sunspots (also called the liver or age spots), de-intensifies the melasma and freckles. It also shows enthusiastic results for PIH, reducing the marks or acne scars. But, it will do nothing to sort out the inflammation arising due to acne. 

Is hydroquinone safe for your skin?

- Let us see what the research has to say. 

Dr. Andrea Suarez, MD, Colorado, Says:

The body has a keen ability to handle hydroquinone. It is present in the edibles we eat and drink naturally, such as coffee, tea, white bread, pears, etc. Our metabolism is well-equipped to process it, and even excrete it out from the body

"Hydroquinone has been used for more than half a century. Yet, no reports have come upon any individual getting any form of cancer.

Some laboratory studies claim that hydroquinone has carcinogenic properties. To contradict their theories, a few have come up with satisfactory rebuttals.

Firstly, the experiments are carried on rodents, specifically the F34 rats, which are insulted with huge doses of hydroquinone. Now, these rodents lack the metabolism to detoxify the ingredient. But humans don't.

Secondly, they are predisposed to develop renal tumors and leukemia by virtue of their high susceptibility to the same.

Dr. Suarez also informs, "Hydroquinone in an ethanol vehicle has a higher systemic absorption rate. Therefore, one should look for non-ethanol based vehicles while going for a topical product."

A 2% topical application of hydroquinone reaches a peak concentration at 0.04 mg equivalence per liter.

According to an Indian report of 2012, a 50-year old woman has suffered from an almost beyond-repair skin condition, exogenous ochronosis, because of using the 2% topical hydroquinone for an unauthorised period of time, and that too, rampantly. 

Precautions you ought to follow

• If you have dry or sensitive skin, hydroquinone can be more drying and irritating to you. But you adjust to the ingredient soon, and the side effects fade off. 
  
• For people with a dark complexion, hydroquinone can cause issues. Get a word from your dermatologist before starting with the product.
  
• Always do a patch test. Apply a little amount on the inside of your elbow. If things go okay for the next 24 hours, you can move ahead with it. 
  
• In cases of pregnancy and breastfeeding, always consult a dermatologist. Although there no studies which prove the ill effects of hydroquinone during such phases, one is advised not to use it.
  
• Carefully follow the instructions mentioned on the packaging. Or, without fail, adhere to all that your doctor has asked you to do.
  
• Don't overdose, i.e., use it in a greater quantity or more than required. It can lead to severe consequences.
  
• Hydroquinone should not be taken orally. If swallowed, rush immediately to a hospital nearby.
  
• Do not apply it around the eyelids, as the skin present there is thin and sensitive. If it gets into the eyes or nose, flush the area with lots of water. 
  
• It can interact with other drugs in a way not right for you. So, abstain from combining it with benzoyl peroxide, hydrogen peroxide, etc.
  
• Adults and children above the age of 12 can use it under a doctor's supervision.
  
• It increases your skin's sensitivity to the sun.
  

Dr. Rohit Batra, dermatologist, Dermaworld skin and hair clinic,Says,

You should wear sunscreens with an SPF of at least 30. Apply it half an hour before going out, and apply a fresh layer after every two hours. Or, as you find it convenient, Make sure you wear protective clothing in the sun.

How do you apply hydroquinone to your skin? 

Firstly, let's take a look at its various concentrations in the market (of course, with a prescription in hand). 

1) Topical cream 

- 2%
- 4% 

2) Lotion 

- 2% 

3) Emulsion 

- 4%

4) Topical solution 

- 2%
- 3% 

5) Topical Gel

- 2%
- 4% 

How to use it?

• If you suffer from PIH, it is recommended to use a 2% salicylic acid face wash/cleanser to control the breakouts. Or, you can opt for a mild glycolic acid face wash/cleanser as well.
  
• Ensure that you have removed all traces of makeup, dirt, and germs from the skin before proceeding with hydroquinone.
  
• The cleaner the skin, the deeper hydroquinone will be able to penetrate and give better results.
  
• Put on a super hydrating gel thereafter. 
  

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Minimalist tip:

Water is an irritant. It dries your face as it evaporates and carries away more of the water along with it. It leads to trans-epidermal dryness, further leads to irritation, which will only worsen your PIH.

• Take a small amount of the product and apply it gently over the affected regions only. Massage on the specific parts to facilitate the maximum absorption of the ingredient.
  
• Wash your hands after use. As it will protect other parts of your skin and clothes from staining.
  
• Follow up with a moisturizer, and then a sunscreen (mineral-based).
  
  You can also use a single product, playing the parts of both - a moisturizer and a sunscreen. 
  
• If you are starting new, it can annoy you with its irritation. Use it on alternate days initially. As you find yourself getting more comfortable, make your way up to using it every day. .
  
  Finally, settle on applying this twice a day, in the morning and at night. 
  
• It takes at least 4 to 8 weeks to show minimal changes. For obtaining the best results, consistently use it for five months. 
  
•  Many skincare experts warn that you should not extend its application over five months at a time. It can be harmful to your skin.
  
  However, you may take a break and resume its applications, only under the guidance of your dermatologist. 
  

Side effects of Hydroquinone

● Common side effects of hydroquinone include: 

These should subside in the first two weeks or less.. If not, visit your doctor soon. 

• Dryness
  
• Inflammatory reaction
  
• Irritation; mild itching and stinging 
  
• Redness
  

● Some of its rare side effects: 

If you face any such symptom, stop using the product. Fix a meeting with your doctor right away. 

• Swelling of the treated areas 
  
• Severe burning, itching
  
• Crusting (formation of dried serum, blood or pus on the surface of the skin) 
  
• Contact dermatitis (rash)
  
• Halo spots (the areas surrounding the dark spots come in contact with the product, and thus, they lighten. They appear lighter than the normal skin and form de-pigmented rings around the treatment spots.) 
  

● Emergency side effects 

Rush to the nearest health facility nearby. 

•  Swelling of the face or tongue or throat (due to a serious allergic reaction) 
  
• Severe dizziness
  
• Breathing problems
  

Exogenous Ochronosis is a rare skin condition, causing blue-black pigmentation in the areas manipulated by heavy doses of hydroquinone. It leaves a disfigured texture on the skin, that is, to a certain extent, incurable. 

You can go for natural (safer) alternatives. 

• Vitamin A and C
  
  They are antioxidants and are commonly used in anti-aging products. Manage the count of free radicals in the skin, and lighten areas of hyperpigmentation. 
  
• Vitamin B-3 (Niacinamide)
  
  Serves many benefits, and one of them being, it prevents the darker areas of melanin gather-up from erupting on the skin's surface. 
  
• Kojic acids
  
  Derived from plants, they help in slowing down the skin's melanin production. 
  
• Alpha arbutin
  
  Almost a clone to hydroquinone, just naturally derived and includes a sugar group. It doesn't actively release hydroquinone into the skin and causes much lesser irritation. 
  

The Bottom Line 

You can take a chance on a chemical peel to lighten the patches. See if it works or not.

Nevertheless, hydroquinone remains the gold standard in the case of skin-lightening ingredients. It comes with potential risks though. But the results that it shows are enticing, which makes you forget the threats accompanying it for a while.

If you are cautious enough and willing to put your skin at stake, you can give it a try.

Keep in touch with your dermatologist on a regular basis, and seek his or her advice where ever you stumble and feel doubtful.

In case you don't get any sign of improvement in first two months, take a break from the product. Meanwhile, inform your dermatologist about the same.