But “the primary concern is the risk of ochronosis, a rare but challenging condition where long-term overuse paradoxically causes darkening of the skin,” says Francesa Lewis, MD, a board-certified dermatologist in Delray Beach, Florida. In other words, you could end up with darker skin, which is the exact opposite of what you were trying to achieve when you set out to lighten discoloration. However, in the off chance that this does happen, it typically takes many months to years of use, she says.
Dr. Lewis adds that there have also been concerns about teratogenicity (fetal abnormalities and birth defects), but these concerns are based on animal studies with high-dose oral hydroquinone. “[There is a] lack of long-term human safety studies,” says Dr. Clark-Loeser, and these issues have not been demonstrated in humans using topical formulations. “More research is needed to understand the long-term effects on humans, importantly assessing any carcinogenic potential.”
If you do choose to use a topical hydroquinone treatment, Dr. Clark-Loeser advises staying alert to any irritation, allergic contact dermatitis, or facial swelling you may experience.
Can you still get hydroquinone over-the-counter?
Since September 2020, the FDA has banned hydroquinone from being sold over the counter. “In the U.S., concentrations of 4% or higher are available as a prescription or compounded to treat stubborn pigment conditions like melasma,” says Dr. Lewis.
According to the American Society for Dermatologic Surgery, the FDA proposed an OTC ban way back in 2006, recommending more studies by the National Toxicology Program (NTP) due to as-yet-unproven concerns that it may cause cancer, as well as concerns over ochronosis—skin darkening (in other words, the opposite of what most hydroquinone users are going for). It wasn’t until the Coronavirus Aid, Relief, and Economic Security (CARES) Act, with which the FDA significantly reformed OTC drug regulation, that we saw hydroquinone yanked from shelves and made available only with a prescription.
What should you not combine with hydroquinone?
If an active ingredient already carries a risk of irritation on its own—looking at you, exfoliating acids—using it alongside hydroquinone in your skin-care routine could be asking for trouble. “Caution is needed when combining hydroquinone with other active ingredients like retinoids or glycolic acid, as the combination can cause irritation or increased sensitivity,” says Dr. Lewis.
What else should you avoid while using hydroquinone? Dr. Clark-Loeser adamantly emphasizes, “Sun exposure!” Additionally, she says you shouldn’t use hydroquinone while taking or applying any medications that may increase your sensitivity to the sun. (And, of course, sunscreen is non-negotiable.)
Are there any effective alternatives to hydroquinone?
Good news: There are treatment options besides hydroquinone that may be worth a shot. Topical tranexamic acid, arbutin, kojic acid, and azelaic acid can all be helpful when addressing hyperpigmentation, either instead of hydroquinone or in tandem with it. Incidentally, SkinCeuticals Discoloration Defense contains all of these besides arbutin.
“In practice, we often use a compounded 6% to 8% hydroquinone regimen for two to four months alongside these other agents, then taper or discontinue hydroquinone while continuing the safer long-term options,” says Dr. Lewis, who adds that in-office treatments like the Perfect Derma Peel, Enlighten Peel, and lasers like Clear + Brilliant can also be great adjuncts.
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