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Authors: Vanessa Ngan, Staff Writer, 2005; Updated: Dr Ian Coulson, Consultant Dermatologist, East Lancashire NHS Trust, Lancashire, UK. Copy edited by Gus Mitchell. September 2021.
Hydroquinone is a skin-lightening agent used topically for the treatment of hyperpigmentation.
Hydroquinone is most commonly used in bleaching creams by patients aged 13 years and over with a dark skin type. It can be used, often in combination with other medications, to treat:
Skin conditions that may be treated with hydroquinone
Hydroquinone should not be used by individuals allergic to hydroquinone or any of the excipients in the formulation such as the preservative metabisulphite. [see Contact allergy to preservatives]
Hydroquinone is used in a cream or lotion formulation in a concentration of 1-5%. It is often found in a combination formulation with other skin lightening agents such as topical retinoids (to increase efficiency) and low potency topical steroids (to reduce irritancy).
In New Zealand and many other countries, hydroquinone is only available on prescription, and may need to be compounded by the pharmacist.
Hydroquinone must be distinguished from monobenzyl ether of hydroquinone which can cause irreversible pigment loss. [see Depigmentation therapy for vitiligo]
Hydroquinone lightens epidermal, but not dermal, pigmentation by reducing the production of new melanin:
Hydroquinone is applied topically just to the hyperpigmented skin only, twice daily for 3 months, after which time many patients maintain their improvement by using it twice each week. If there has been no benefit after 3 months of treatment, then the hydroquinone should be stopped. Management of the underlying cause of the hyperpigmentation is also recommended.
When initiating hydroquinone treatment, it is advisable to:
Hydroquinone is particularly effective for the treatment of postinflammatory hyperpigmentation which is unlikely to recur provided the underlying inflammatory dermatosis is also controlled.
In melasma, 70% of sufferers notice clearance or reduction in pigmentation with twice daily hydroquinone used for three months. This improvement can be maintained in 50% of individuals with twice weekly application.
Response of melasma after three months of hydroquinone
Hydroquinone does not treat pigmentation in the dermis.
Melasma can be resistant to treatment and usually requires combination therapy and multiple therapeutic approaches, of which hydroquinone is one component.
Hydroquinone can cause mild irritant contact dermatitis when used in concentrations above 4%. A short drug holiday and/or application of a topical steroid will usually settle the reaction.
Commercial formulations of hydroquinone contain the preservative metabisulphite, which can cause an allergic reaction.
Concerns have been raised about the safety of hydroquinone in Europe, Japan, and the USA due to:
Other reported cutaneous adverse effects of hydroquinone include:
The safety of topical hydroquinone has not been established in pregnancy and lactation.
Nail pigmentation due to hydroquinone use
If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the Australian Therapeutic Goods Administration and the US Food and Drug Administration) or a national or state-approved formulary (eg, the New Zealand Formulary and New Zealand Formulary for Children and the British National Formulary and British National Formulary for Children).
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