Hydroquinone is one of the most effective creams for pigmentation and melasma.
Here’s all you need to know before you start treatment.
What is hydroquinone?
Hydroquinone is a skin-lightening medical cream.
It works by bleaching your skin to lighten hyper-pigmentation like melasma and post-inflammatory hyper-pigmentation.
How does hydroquinone work?
Hydroquinone bleaches your skin by decreasing the number of melanocytes cells.
Melanocytes are the cells that make melanin, which is the brown pigment that causes pigmentation.
If you have hyperpigmentation, this means that your skin has more melanin because of an increase in melanocyte production.
By controlling your melanocytes and their production of melanin, your skin tone will become more even.
Hydroquinone cream takes an average of four weeks to take effect.
You will require several months of consistent use before you see the full results.
What can hydroquinone treat?
Hydroquinone is used to treat skin conditions related to hyperpigmentation (excessive brown pigments).
Is hydroquinone safe for all skin types?
Hydroquinone is generally well-tolerated by most patients. However, there are always a few exceptions.
If you have dry or sensitive skin, you may find that hydroquinone causes further dryness or irritation. This dryness and sensitivity usually improves as your skin adjusts to hydroquinone.
Patients with oily skin are less likely to experience these side effects.
The ingredient tends to work best on fair skin tones.
Is hydroquinone FDA approved?
In 1982, the U.S. Food and Drug Administration approved hydroquinone as safe and effective.
Several years later, concerns about safety prompted retailers to pull hydroquinone from the market. The FDA went on to discover that many of the products in question contained contaminants like mercury which were the causes of the adverse effects rather than hydroquinone itself.
Hydroquinone is now HSA Singapore and US FDA approved for medical use.
In fact, in the US, hydroquinone can be sold over the counter in 2 percent concentrations.
What is Tri-Luma?
Tri-Luma® is the only FDA-approved melasma treatment with 3 active ingredients.
It is indicated for short-term treatment of the dark pigmented spots associated with moderate-to-severe facial melasma.
You can use it once a daily for up to 5-6 months.
Tri-Luma Melasma Cream contains these 3 active ingredients:
1. Fluocinolone acetonide 0.01% is a mild corticosteroid that reduces inflammation.
2. Hydroquinone 4% is a depigmenting agent that reduces melanin pigment production to help lighten your skin tone.
3. Tretinoin 0.05% works by increasing the skin cell turnover rate, which helps to exfoliate your skin.
It is important to note that Tri-Luma® cream should always be used in conjunction with sun-avoidance and sun-protection measures, like using sunscreens.
Do note that Tri-Luma® may improve the appearance of melasma but is not a cure for melasma or pigmentation.
In Singapore, Tri-Luma is only available by prescription from a medical doctor/ dermatologist.
What is Kligman’s formula for melasma / pigmentation?
Kligman’s formula for pigmentation treatment is a cream that consists of 3 active ingredients – hydroquinone, tretinoin and a steroid. As you can see, Kligman’s formula is very similar to Tri-Luma.
The original Kligman’s formula consists of hydroquinone 5%, tretinoin 0.1%, and dexamethasone 21-acetate 0.1%. It was found to be effective in the treatment of melasma.
Other observations noted include:
- Omitting any one component resulted in a loss of effectiveness.
- Lowering the concentrations of the components decreased the frequency of irritancy, but also decreased the potency of the mixture.
- Fluorinated steroids were more effective than non-fluorinated steroids.
The synergistic effects have also been noted. Tretinoin prevents the oxidation of hydroquinone and improves epidermal penetration while the topical steroid component reduces irritation from the other two ingredients and decreases cellular metabolism, which inhibits melanin synthesis.
Does my melasma pigmentation worsen after I stop Hydroquinone or Tri-Luma?
No, your melasma usually does not worsen after stopping hydroquinone or tri-luma.
Your results will be maintained provided you minimise your sun exposure and take good measures for sun protection.
How to use hydroquinone safely
First, do a patch test before your first full application. This will allow you to see how your skin reacts to hydroquinone and whether you’ll have any side effects.
Start every other night, instead of daily
If you don’t experience any side effects, you should be able to safely add it to your skin care routine. But I suggest that you start applying the creams every other night before increasing the frequency to nightly applications.
Use before moisturiser
You should apply hydroquinone/tri-luma after cleansing and toning, but before you apply your moisturizer.
Start with small amounts of hydroquinone
Take just a small amount of the product and apply it evenly across the entire area of skin. Gently massage into your skin until it’s completely absorbed.
Sun protection – a MUST!
You should also wear sunscreen while using this ingredient. Sun exposure can not only make hyperpigmentation worse, but also reverse the effects of your hydroquinone treatment.
Sunscreen is usually the last step of a skin care routine. Be sure to reapply as needed throughout the day.
The key to results – Consistency!
Consistency is key to treating hyperpigmentation. You’ll want to use this ingredient every day for maximum results.
Also, a combination therapy with Pico Lasers also help to achieve faster and better results.
What are the possible side effects and risks of Hydroquinone?
Hydroquinone is deemed safe in Singapore. There isn’t any clinical evidence currently to suggest that hydroquinone is harmful to humans.
However, minor side effects are still possible.
Hydroquinone may cause redness or dryness initially, especially if you have sensitive skin.
These side-effects should fade as your skin becomes used to the product.
Chronic use of high concentrations of HQ (>5%) have been reported to produce onchronosis and colloid milium.
As such, you shouldn’t use products with this ingredient for more than five months at a time.
What is the price of Hydroquinone/ Tri-Luma in Singapore?
The price of Hydroquinone/ Tri-Luma in Singapore is around $150 to $250 per tube (15g). Prices may vary amongst clinics and doctors.
Generic formulations of hydroquinone may be cheaper.
At Sozo Aesthetic Clinic, we use the original Tri-luma by Galderma. This is what we believe to be the most stable and widely used formulation.
Alternatives to Hydroquinone for Pigmentation treatment
If you prefer not use a chemical agent like hydroquinone, you might want to consider these natural skin-lightening pigmentation products.
You might want to look for skin creams/ products with these active ingredients:
Mechanism of action
- Although the entire mechanism of action for azelaic acid (AzA) is not fully understood, AzA has anti-inflammatory, antibacterial, and anti-keratinizing effects, which make it useful in a variety of dermatologic conditions.
- 20% azelaic acid has been shown to have greater efficacy than HQ 2% in a 6-month study.
- It is equally as efficacious as HQ 4%.
Safety and tolerability
- Topical administration of 20% AzA has produced pruritus, burning, stinging, and tingling in 1% to 5% of patients.
- Other adverse reactions, such as erythema, dryness, rash, peeling, irritation, dermatitis, and contact dermatitis, have been reported in less than 1% of patients.
- Ascorbic acid is thought to decrease pigment by interacting with copper at the active site of tyrosinase and by reducing dopaquinone by blocking dihydrochinindol-2-carboxyl acid oxidation.
- 5% ascorbic acid cream is inferior to 4% hydroquinone cream although ascorbic acid causes significantly less irritation than hydroquinone.
- It may be a useful adjunctive treatment in patients who cannot tolerate hydroquinone because of its side effects
- Kojic acid is a molecule produced by Aspergilline oryzae and Penicillium spp. It acts as a tyrosinase inhibitor that works by chelating copper at the enzyme’s active site.
- Studies examining the efficacy of kojic acid in melasma have shown mixed results.
- Kojic acid is a known sensitizer.
- This agent is usually available over the counter.
- Also known as nicotinamide, it is the biologically active amide of vitamin B3. It acts by reducing melanosome transfer via interfering with the interaction between keratinocytes and melanocytes.
- Side effects from niacinamide are mild and include erythema, pruritus and a burning sensation.
With so many treatments out there, how do you decide which is best for your skin?