In recent years hydroquinone has gotten a really bad reputation and is banned in several countries. Primarily because it was reported to cause cancer. This is not correct, however, most people still give it the side-eye at least in public but use it under the counter. When it comes to hyperpigmentation Hydroquinone remains the most effective depigmenting agent. That, in turn, is the reason that people who bleach their skin tend to reach for it with somewhat disastrous results –Ochronosis
So what is ochronosis?
It is a symptom of long term use of hydroquinone which shows up as a blue-black colour on the cheekbones, knuckles of the fingers and the feet. The colour is due to the deposit of a homogentisic acid in the connective tissues of the body. But is visible in areas which are e constantly exposed to sunlight.
Causes of Ochronosis
This is caused by long term use of hydroquinone, however certain factors make it more likely to develop
Use of hydroquinone on your whole body
Hydroquinone should on be used on pigmentation. Application on your whole body means that much more will be absorbed (the skin is the largest organ) and ochronosis will develop much faster.
Using a prescription dose
Hydroquinone comes in 2 versions 2% over the counter and 4% prescription dose. Using the higher concentration makes you much more likely to develop ochronosis.
If you are bleaching your skin and do nay wear sunscreen or have a job that has you out in the sun constantly you are likely to develop this. Which is why it is more likely to develop in women of lower socioeconomic classes, they tend to work outside.
Fitzpatrick Scale IV-VI
The darker you are the more likely you are to develop ochronosis; I did a post on the skin classification using the Fitzpatrick scale with I being the lightest and VI the darkest. Anyone IV and above using hydroquinone is more likely to develop it
Length of Use
Hydroquinone is not recommended for long term use and can be used safely for a maximum of 4 months before a break is required . If you still have pigmentation you can use hydroquinone for 3-4 months give a 1-2 month break then start again. Do not use it continually for long periods of time.
How to treat ochronosis
Ochronosis is notoriously difficult to treat and tends to reoccur even when then marks initially fade. Prior to treatment, you need to stop the use of any hydroquinone contains products and uses sunscreen as your life depends on it.
- Topical treatment: You can apply retinoids (vitamin A), Vitamin C and E topically to help with fading the pigmentation. Retinoids exfoliate the skin while victim C and E protect it from free radicals including UV rays
- Chemical peels: Like with other types of hyperpigmentation chemical peels glycolic acid and TCA can be useful in reducing the pigmentation
- Laser: Lasers are the final bus stop when it comes to treating ochronosis as they use a specific wavelength of light to destroy the pigment.
- Use low dose hydroquinone 2% or less
- Do not use on the whole body just apply on your spots
- Use sunscreen when using hydroquinone and stay out of the sun
- Only apply at night to avoid its reaction to sunlight
- Do not use consistently for long periods always give a break in-between
I have a detailed post on called THE DANGERS OF SKIN BLEACHING AND THE QUEST FOR WHITENESS AT ALL COSTS, which illustrates risks of bleaching if you live in the tropics. If you have already bleached your skin 5 WAYS TO AVOID SKIN CANCER IF YOU HAVE BLEACHED YOUR SKIN tells you how to protect yourself. To learn how to control your acne and treat hyperpigmentation from acne or melasma and feel free to share on your social media and subscribe below