At What Point Will Hydroquinone Stop Working on Fading Age Spots?

Age spots don't clear up well with hydroquinone creams.  I find it a waste of money and time.  Electrofulguration, freezing or lasering the spots do great and is easy to get done quickly and not that expensive.  Sincerely,

David Hansen,MD

Hi Misty.  There are definite limitations to what hydroquinone can do and how long it should be used for.  The FDA recommends considering a resting period after 90 days of continued use of hydroquinone.  For our patients that are using between 6% - 8% products, we have a mandatory 30 day washout period after 90 days of continued usage.

As an alternative, you should seriously consider finding a laser practitioner in your are that is capable of offering q-switched Nd:Yg laser treatments.  This is the same laser used for tattoo removal and is an excellent (and permanent) method for sun damage removal.  We like the Palomar Q-Yag V and the Hoya Conbio Medlite C6 lasers.  Good luck.

We use both Hydroquinone and Retin A to lighten skin pigment, including sunspots. Typically we recommend using 4% hydroquinone twice a day for no longer than 4 months. Retin A, on the other hand, can be used long term. It's also important to use sunscreen and avoid sun exposure when you are trying to lighten pigment. In my experience, sunspots will get lighter but will not fade completely. I would recommend discontinuing the use of hydroquinone since you've already seen improvement from it. You may need to consider laser treatment to help fully remove the sunspots. 

Hydroquinone and Retin A are very commonly used to lighten skin pigment, including sunspots.  Typically we would use 4% hydroquinone twice a day, but I usually don't like my patients to use for longer than 4 months at a time.  Retin A can be used long term.  Also sunscreen and sun avoidance are a must when trying to lighten pigment.  However, from my experience sunspots will only get lighter and not fade completely.  Often time there will be a need to do some laser to help remove them more fully.  I wouldn't recommend for you to continue with the hydroquinone at this point since you've already gotten some improvement from it.  It probably won't do any more and you may need to have an additional procedure to get further benefit.  

I recommend that patients stop using hydroquinone for at least a few months after a 6 month course.  This is the length of time the medication Triluma, a prescription containing hydroquinone, was tested for safety and approved by the FDA.  Since you are from California, the most important thing is protection from the sun.  A hat is imperative to protect your skin from darkening once again.  This in conjunction with a good quality, preferably zinc or titanium based spf 30 or above sunscreen can make a huge difference.  

When you stop hydroquinone, you can continue tretinoin (Retin A), glycolic products, and lightening creams that contain Kojic acid (not HQ) to further help your pigmentation.

Hope that helps!
Madeline Krauss, M.D.

You did not mention what strength hydroquinone you have been using. Prescription strength 4% hydroquinone is better than any OTC product for lightening dark spots in the skin. These dark spots are typically due to chronic sun damage so daily use of sunscreens is essential in your treatment. Combining prescription-only tretinoin cream with hydroquinone will make it even more effective. Therefore, the most effective way to reverse the effects of chronic sun damage to your skin is by using a combination of these two prescription strength medications: tretinoin cream and 4% hydroquinone. I recommend the Obagi Nu-Derm System which uses both tretinoin cream and hydroquinone to visibly lighten age spots as well as the fine lines and wrinkles that are due to chronic sun exposure. They have found a way to make these creams approximately 3 times more effective than simply applying them to your skin. I typically recommend a 3 to 6 month course to achieve the desired effect and then to switch to maintenance therapy of approximately twice weekly applications.