Hydroquinone: What you need to know, to maximize it’s benefits and prevent resistance
In the world of medical aesthetics, hydroquinone is often a necessary part of skin care. It is the gold standard for treating dark skin irregularities known as hyperpigmentation. As effective as it is, there is a rising concern regarding the number of people who are using hydroquinone incorrectly, without on going professional guidance. Many of those who are using hydroquinone do not understand the risk of hydroquinone resistance or how to properly use it, as to enhance efficacy. It is important to use hydroquinone in a way to maximize it’s benefit, before the skin builds a resistance and how to properly transition off, to reduce incidence of rebound hyper pigmentation. Always seek a professional guidance before starting or continuing hydroquinone use. It should be used only under the strict supervision of a professional.
Why do we need Hydroquinone?
Hydroquinone is the single most effective topical ingredient for treating skin discolorations. Skin discolorations can include sun spots, Melasma and Post Inflammatory Hyperpigmentation (PIH), pigmented acne scars. When the skin is inflamed it can respond by over producing melanin, this inflammation can come from acne, injury, surgery or aesthetic procedures such as laser or chemical peels. UV exposure and hormones can also induce skin discolorations. In the world of medical aesthetics we are really dependent on the ability of hydroquinone to quickly correct hyper pigmentation. There are non-hydroquinone skin brighteners that are very good products, however they are not as effective as hydroquinone. That does not mean that botanical lighteners do not have a place, as you will learn, both hydroquinone and non-hydroquinone brighteners are important.
Resistance to Hydroquinone
Hydroquinone works by inhibiting tyrosinase, which is necessary for melanin production. It is believed that with extended hydroquinone use, the skin will compensate by increasing tyrosinase. This would causes the skin to become resistant to the effects of hydroquinone. When the skin becomes resistant to the effects of hydroquinone it will quit improving the hyper pigmentation. To prevent building resistance, it is not recommended to continue use for extended periods of time with out cycling off. It is usually recommended to cycle off hydroquinone after about 4-6 months. If needed, hydroquinone may be resumed after about 2 months. If you stop hydroquinone “cold turkey”, there is a risk of rebound pigmentation. To prevent rebound pigmentation, it is generally recommended to transition your skin off. While transitioning off and breaking from hydroquinone, continued stimulation with a retinoid is beneficial. When it is time to transition off your hydroquinone, you may begin to incorporate a non-hydroquinone skin brightener. There are several professional products that may be recommended. Exact regimens will vary individually, depending on skin condition and any skin treatments, such as laser treatments or chemical peels, that are planned. Do not attempt to cycle off hydroquinone without professional guidance!
Maximize Hydroquinone Effectiveness
When using hydroquinone to treat hyper pigmentation, the goal is to correct the condition before the skin builds resistance. In order to maximize effectiveness, we need to use a high quality hydroquinone product in the appropriate dosage, along with products that optimize penetration, assist in correction and protect from exacerbating factors.
We want to use enough of hydroquinone to reach correction, so a skin care professional needs to show you how to measure your hydroquinone and give you a time frame that you should expect to run out of product. Using hydroquinone every morning and night is a common protocol for treating facial skin.
We want the hydroquinone to have optimal ability to penetrate and work. Prepare the skin by cleansing with an appropriate cleanser. This would exclude anything that does not sufficiently clean the skin or leaves any occlusive film, this could inhibit product penetration. For this reason, I generally do not recommend cleansers like CeraVe or Cetaphil. Anything that is too harsh or active, should also be avoided, as we do not want to induce any unnecessary inflammation or irritation. After cleansing, an appropriate toner should be used, this will restore the skins PH balance after cleansing, preparing it for corrective skin care products. (astringent is not toner). Hydroquinone should be applied after toner, unless you have been instructed to use a Vitamin-C serum or other corrective serums. Always, confirm with your Esthetician or provider, the order your products should be applied.
When Hydroquinone is used with a mild exfoliant and Tretinoin (Retin-A), the pigment will be more evenly distributed. The goal is not just to suppress the production melanin (pigment), it is to have even distribution of the pigment. When the skin has hyper pigmentation, the melanocytes are not functioning properly. Not only is there an over production of melanin, but the pigment is not being evenly distributed to skin cells called keratinocytes. When Hydroquinone is used with Tretinoin, it works to evenly distribute the pigment. A mild chemical exfoliant will enhance the process by increasing the skin cell turnover. It is important that the exfoliant be appropriate to your skin type and personal skin care regimen, to reduce risk of any unnecessary inflammation. Here is the icing on the cake, tretinoin will also treat acne, increase collagen production in the dermis, as well as glycosaminoglycans such as Hyaluronic acid that bind to water and improve skin moisture. There is also evidence that tretinoin may positively effect gene expression in the skin. – Yes, please! I want all of that.
Sun protection is important for several reasons. 1) UV exposure stimulates the production of melanin, while hydroquinone is working to suppress it. It literally, defeats the purpose of using hydroquinone, if you do not have proper sun protection. 2) Hydroquinone, tretinoin and exfoliants can all cause photosensitivity of the skin. 3) Heat, including heat from the sun dilates capillaries in the skin and induces inflammation, which can exacerbated pigmentation problems. 4) UV exposure causes skin discolorations, free radical damage and breaks down collagen and elastin.5) UV rays damage DNA and causes skin cancer, and melanoma can be life threatening.
Your sunscreen should be an SPF 30 or higher and should have zinc oxide. Zinc Oxide can help by blocking some of the UV induced heat, that contributes to inflammation and exacerbates hyper pigmentation. Zinc also provides broad spectrum protection from UVA/UVB rays without the irritation occasionally seen with chemical sunscreens. Professional zinc products are more elegant and will look better on the skin. Using a moisturizer, BB Cream or cosmetic with an added SPF, is not enough. It is important to have an actual sunscreen, with high broad spectrum coverage. Sunscreen should go on after any moisturizer, it is the last thing you put on, but before makeup. Sunscreen needs to be used EVERY day!
Topical antioxidants are useful for many reasons, but in regards to skin discolorations we especially like topical Vitamin-C. First, Vitamin-C reduces oxidized dopaquinone, which helps further brighten the skin. Perhaps, more importantly, Vitamin C helps to reduce inflammation in the skin that can cause or exacerbate hyper pigmentation. Some antioxidants, including Vitamin-C also have photo-protectant ability, enhancing the effectiveness of sunscreen. They works by neutralizing the UV rays, rather than reflecting or absorbing UV rays like a sunscreen, so use them together to maximize your protection. We recommend using an l-ascorbic acid form of vitamin c, in serum form. A quality l-ascorbic acid, needs to be packaged in a glass bottle with a glass dropper, the bottle should be dark to reduce oxidation of the product.
Not all skin care products play well together and there are some skin care products that may be contraindicated to your personal skin care regimen. For example, you should not use any product that contains benzoyal peroxide with products that can oxidize, such as Hydroquinone and Vitamin-C Serums. Always inform your Esthetician or skin care provider of the products you are using, and do not add anything new without having it approved first.
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