What Is Hydroquinone and What Are Its Uses?

Hydroquinone is a topical treatment for conditions that discolor the skin, such as melasma, eczema, age spots, and acne scars. Available over the counter as well as in prescription-strength formulations, this cream or gel works to lighten and fade away darker spots and patches on the skin.

In use since the 1960s, the safety of hydroquinone remains controversial. Because of links to malignancy and toxicity at high doses in animals, the U.S. Food and Drug Administration (FDA) even proposed a ban on the product in 2006. In light of additional research, it withdrew the call, and the treatment remains available in the United States.

This article provides a quick look at how hydroquinone works and the skin conditions it treats. It also discusses how to use it safely, potential side effects, and potential alternatives.

How Hydroquinone Works

Hydroquinone treatment lightens the skin gradually and has a reversible effect. It does this by interfering with the production of melanin, the black or brown substance responsible for the pigmentation of the skin, eyes, and hair. Acting on melanin-producing cells, or melanocytes, hydroquinone prevents the conversion of dihydroxyphenylalanine (DOPA) amino acids to melanin by affecting the activity of its precursor, tyrosine.        

Applied over time, hydroquinone has a twofold effect. Not only does it interrupt the production of melanin, but it also interferes with the reproduction of melanocytes, reducing their number. This leads to the desired lightening effect of treated areas.     

Skin Conditions That Benefit From Its Use

A wide range of dermatological conditions cause darker spots, patches, and blemishes on the skin, which is clinically referred to as hyperpigmentation. With regular application, hydroquinone lightens the skin to correct this set of issues. Here’s a quick breakdown of the conditions that this treatment can improve.

Melasma

The formation of brown, tan, bluish, or gray patches or freckles on the face is the hallmark of melasma, also known as chloasma or “pregnancy mask.” The discoloration typically affects areas of the face that get regular sun exposure. This non-life-threatening condition is triggered by hormonal changes or as a side effect of certain medications.

Most commonly seen in younger women with brown or light brown skin, though anyone can develop it, melasma most often results from:

• Pregnancy
• Oral contraceptives (birth control pills)
• Hormone replacement therapy, which is often a treatment for menopause

In some cases, melasma patches and spots go away on their own. For instance, pregnant people may see them fade after delivery.

Eczema

Also known as dermatitis, eczema refers to a set of inflammatory responses in the skin. This causes scaly, dry, and itchy skin, as well as rashes on the face, elbows, knees, and on hands, and feet. Eczema is especially problematic because scratching affected areas can lead to bleeding or infection.

The exact causes of this noncontagious skin disorder are unknown, though evidence suggests it’s likely caused by a combination of genetic and environmental factors. Eczema is most common in infants or children, and in some cases, it fades with age. However, it can affect adults too and is typically a long-lasting or chronic condition.

Acne Scars

When the pores of the skin become clogged with oil or dead skin particles, acne arises, characterized by bumps and spots on the face and body. These may range from blackheads, red spots (known as pimples), and whiteheads, in which the affected pore has filled with pus. Commonly arising in adolescence, 80% of teenagers experience acne, though it can affect people of all ages.

As the affected skin heals, a thicker substance called collagen develops, which can cause permanent scarring and discoloration of the skin. Several types of scarring occur, including:

• Ice-pick, in which there are small pinpoints in the skin
• Boxcar, or round or oval depressions in the skin.
• Rolling, characterized by small indentations in the skin caused by bands of scar tissue

You’re more prone to develop acne scars when the acne is more severe, you pick or pop whiteheads or blackheads, the condition is long-standing, or you have a family history of them.

Psoriasis

Psoriasis is a chronic autoimmune condition that affects the skin by speeding up the lifecycle of skin cells. Its typical signs are patches of thickened, red skin and the appearance of silvery scales. This discoloration often affects the face and is also seen in the scalp, knees, elbows, lower back, palms, and soles of the feet.   

Age Spots

Also known as liver spots, age spots are brown and black spots on the skin that are often exposed to the sun. They typically arise as a natural result of aging or due to cellular damage caused by sunlight or ultraviolet (UV) rays. Unrelated to any other disease, age spots are painless. They can, however, resemble other, more serious skin conditions.   

Is a Skin-Lightening Cream Safe for All Skin Types?

Broadly speaking, hydroquinone creams and gels are well tolerated and safe to use for all skin types. Despite reports of toxicity in animal studies, when performed under a dermatologist’s supervision, the risk of side effects or negative effects is minimal. Most complications arise with unsupervised, over-the-counter use.

This treatment may not be effective in every case. Discomfort can worsen when applied to sensitive or very dry skin and may be prone to additional irritation when using hydroquinone. Prolonged use may also cause the discoloration to worsen if you have darker skin.

How to Use It

As noted, hydroquinone creams or gels come in over-the-counter 2% and prescription-strength 4% solutions, such as Tri-Luma. Generally, it’s advised to test the solution on a smaller area first to see if there’s irritation or any side effects before full application.  

Here’s a quick rundown of how to apply hydroquinone:

• Thoroughly clean your hands and face.
• Make sure the target area is dry before application.
• Apply a thin layer of cream or gel to the area and gently rub it into the skin.
• Wash your hands afterward to prevent your fingertips from lightening.

Critical for successful treatment is protection from the sun. You’ll need to wear strong sunscreen and hats every day and work to avoid direct sunlight. Exposure further damages the skin and can prompt hyperpigmentation to return.  

What Happens When You Stop

The effect of hydroquinone on skin pigmentation is reversible. If you stop, the melanocytes affected by treatment start to resume normal activity, causing the blemishes or spots to gradually reappear.

Because long-term use can increase the risk of side effects, dermatologists recommend the daily application for three to six months, followed by rest periods of less frequent maintenance use. These maintenance periods—in which hydroquinone is only applied two to three days a week—have been shown to preserve the results of treatment up to six months after stopping. 

Potential Risks and Side Effects

Contrary to the concerns raised by the FDA, hydroquinone has consistently proved safe, especially under physician supervision. That said, side effects can arise with this treatment. These may include:

• Severe itchiness in the skin
• Inflammation of the skin
• Redness (erythema) of the skin
• Skin sensitivity or irritation
• Red, itchy rashes (contact dermatitis)

Long-term use, especially when it’s unsupervised, can lead to ochronosis. This is characterized by patches of diffuse bluish or black pigmentation on the skin, broken up with lighter, curved deposits.

Natural Alternatives to Hydroquinone

Though hydroquinone has cemented its place in the treatment of hyperpigmentation, it isn’t the only approach to lightening skin. Even though it isn’t dangerous, some people may have concerns about the idea of applying a chemical daily or find treatment ineffective. As laid out below, there are several natural alternatives to hydroquinone.   

Antioxidants Such as Vitamins A and C

Present in a range of beauty products and foods, antioxidants, especially vitamins A and C, may also help treat hyperpigmentation on the face. Researchers have found vitamin C, also known as ascorbic acid, to inhibit the production of melanin and be effective against blemishes and spots.

Vitamin A and compounds of its family (retinoids) can also treat spots and blemishes. Topical creams with this antioxidant are considered a viable alternative to hydroquinone for skin lightening.    

Plant-Based Acids

Plants also produce antioxidants and acids that can help with hyperpigmentation. Often found in cosmetic solutions and creams, a range of naturally derived, botanical extracts and agents may help, including:

• Arbutin
• Coffeeberry  
• Grapeseed
• Aloe
• Marine algae
• Pycnogenol

Vitamin B3

Vitamin B3 is also known to treat hyperpigmentation. It’s an ingredient in a number of combined formulas for skin lightening. Known to smooth wrinkles and lines, this vitamin helps suppress the activity of tyrosinase, thereby limiting melanin production.

Summary

Hydroquinone is a topical agent for treating discoloration on the skin due to age spots and acne scars, as well as dermatological conditions like melasma and eczema. Available as a cream or gel, it’s available both over the counter or with a prescription. Over time, the use of hydroquinone causes blemishes to fade, though prolonged use can cause side effects. Though there have been concerns about safety, used properly, it’s been found to be well-tolerated and effective.

A Word From Verywell

Though the skin conditions hydroquinone treats aren’t dangerous, blemishes, patches of discoloration, and other issues can significantly impact self-esteem and quality of life. Nowadays, there is much you can do to correct these issues and restore your self-confidence. If you're unsatisfied with how your skin looks—or aren’t sure what’s on your skin—it’s worth reaching out to a dermatologist and exploring your options.