Hydroquinone and Ochronosis For Skin Lightening?

I have olive complexion. My doctor presribed a custom formula for skin lightening containing Hydroquinone 8%, tretinoin .1%, hydrocortisone .5%, and clindamycin 1%. I read on the internet about skin darkening (ochronosis) with hydroquinone use. I would like to try using the presription but am worried about this side effect. How likely is it to happen? Are there steps to prevent this from happening like using it intermittently once I have acheived a good skin tone? Taking breaks, etc? Thank you!

Doctor Answers 2

Hydroquinone and Ochronosis For Skin Lightening?

Thank you for your question. Any bleaching creams including hydroquinone should be used for a maximum of 2-3 months and then discontinued. You may take a break for 3 months and then resume usage. Once your skin has lightened in color the best thing to do would be to avoid sun exposure and then to use an sunscreen with SPF 30 with zinc oxide to protect your skin and prevent it from re-darkening. You may need a maintenance program.  Be certain to be under the supervision of a board certified dermatologist for the most effective and safe treatment options. I hope this helps.

Bay Area Dermatologist
3.9 out of 5 stars 12 reviews

Do not use for more than 6 months

Hydroquinone is a bleaching agent that specifically inhibits the enzyme homogentisic acid oxidase, which can in cetain patients result in the accumulation of this substance on the collagen fibers in tissues where it is applied. This reaction over long term use can result in grey brown and bluish black patches and bumps over the cheeks and forehead called exogenous ochronosis. The majority of patients affected with this reaction have darker skin tones, and high rates of this problem have been reported in South Africa; this was thought possibly to be secondary to the high potency of the hydroquinone and combination with other ochronotic agents such as phenol and resorcinol, (however exogenous ochronosis has been reported with use of even in as low as 2% hydroquinone). It also appears in studies that exogenous ochronosis was also linked with prolonged hydroquinone use longer than 6 months. Limited studies have revealed only about 22 reported cases of exogenous ochranosis in more than 50 years of use in the US, so it is not reported very commonly. As a general rule when prescribing hydroquinone, I usually try to use the lowest potency possible, only once daily application and advise patients regadless of their response to not use the product longer than 6 months, and use strict photoprotection.

Samantha Fisher, MD
Stuart Dermatologist
5.0 out of 5 stars 2 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.