Posts Tagged ‘obagi clear’
There are countless skin care products available to treat skin discolorations known as “hyperpigmentation”, such as brown spots and melasma. There is also just as much confusion and misinformation, surrounding topical Hydroquinone and Non- Hydroquinone products. The fact is they are both necessary, as each have a place in correcting and maintaing pigment irregularities.
I am a proponent for Hydroquinone and for good reason, when used correctly it is arguably the most effective topical for treating hyperpigmentation. I am also a proponent for Non-Hydroquinone skin brighteners, because I do not support using Hydroquinone indefinitely without pulsing on and off.
If you understand how hyper pigmentation occurs, you are better able to understand how to treat it. The process of producing pigment (melanogenesis) is complex, with many process, so I am giving the short version. When the skin has hyperpigmentation, it means that, there are melanocytes that are over producing melanin (pigment) AND that those pigment cells are not being evenly distributed to the skin cells called keratinocytes.
Something must first, trigger the increase of tyrosinase activity, this can be sun exposure, hormones or inflammation. Tyrosinase is an enzyme in the skin that controls the production of melanin. One of the main goals in treating hyperpigmentation is to inhibit the tyrosinase, so that it will not trigger the overproduction of melanin (pigment). Products that aim to do this use ingredients that we call “tyrosinase inhibitors”. Hydroquinone is a strong tyrosinase inhibitor, however there are also non-hydroqinone tyrosinase inhibitors that are effective.
Hydroquinone is a strong tyrosinase inhibitors and very effective at treating hyper pigmentation. There is concern, however that with extended use the skin may become resistant to the effects. This is why it is important to use hydroquinone under professional guidance. The general idea is to maximize correction, before you build resistance. Many dermatologists and skincare professionals are now recommending pulsing on and off hydroquinone. If you are using or plan on using hydroquionone products, I recommend you read “Hydroquinone: What you need to know, to maximize it’s benefits and prevent resistance”.
When you are pulsing off hydroquinone, you may want to use a non-hydroquinone skin brighter. Look for a brightener with tyrosinase inhibitors. Ideally, non-hydroquinone skin brighteners should be formulated with a combination of ingredients that will have an effect on the various stages of melanogensis (the formation of pigments). Antioxidants and exfoliants play a role in melanogensis and should be part of a skin care regimen, along with a tyrosinase inhibitor. I am including a short list of some commonly used ingredients in Non-hydroquinone brighteners.
Non-Hydroquinone Lighting/ Brighting Ingredients
Arbutin (Bearberry Extract)
Licorice Root Extract
Hydroxyphenoxy Propionic Acid
For best results begin by preparing your skin to best absorb the topical products you are using, this is done by properly cleansing and toning skin. Topical antioxidants and a broad spectrum SPF, are a MUST, because they help block the effects of “triggers”. We also recommend some type of chemical exfoliant, such as glycolic or lactic acid. These help by exfoliating melanin filled skin cells from the surface, which accumulate and cause pigment to be more dense, making it look darker. Retinoids such as tretinoin (Retina-A) work by inhibiting the transfer of pigment to skin cells, this blends pigment for even skin tone. Retinoids also work as a tyrosinase inhibitor. Finally, if you are not seeing the results you want with topical products alone, consult with a skin care provider to discuss which treatment options are best for you. Typically, we recommend chemical peels or PhotoFacials (IPL or BBL), depending on skin type and conditions being treated.
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Hydroquinone has been the gold standard for treating hyperpigmentation for over 50 years, but some confusion about hydroquinone has developed over the past few years. Common rumors include, hydroquinone has been banned or that it causes cancer. A lot of information found on the internet misrepresents hydroquinone by omitting some of the facts related to Hydroquinone studies and the FDA’s proposed rule.
I personally use hydroquinone on my skin to treat melasma and hyperpigmentation. I love what hydroquinone does for my skin and I have not been able to duplicate the results with other skin lighteners, however health is always going to outweigh the benefit of beautiful skin. I certainly would not want to use anything that is unsafe, furthermore I consider my self an advocate for my clients. It is important that my clients feel confidant in my knowledge of skin care and even more important that they trust that I always have their best interest in mind. I have spent a lot of time educating my self on hydroquinone and I aim to clarify some of the confusion.
What is Hydroquinone
Hydroquinone is an active ingredient used in topical creams and cosmetics as a depigmenting agent to treat skin discoloration such as melasma. Topical skin lightening creams containing Hydroquinone first became available in the United States in 1955. Hydroquinone has been described as a ubiquitous chemical, meaning it is something that we are exposed to as part of our daily life. Hydroquinone occurs in some plants as free hydroquinone or as arbutin. Arbutin (glucosylated hydroquinone) is found in the leaves and fruits of many plants that are used for food and bacteria in the intestines can transform it into hydroquinone. Hydroquinone and Arbutin can be found in foods such as cranberries, blueberries, pears, beans, broccoli, onions tea, coffee, beer, red wine, all-wheat bread and cereals (concentration may exceed 1%). Hydroquinone also has a number of other uses, it is used as an antioxidant for rubber, a reducing agent for photographic developing solutions, a stabalizer in paints and varnishes. It is also found in hair dyes and nail polish. The list goes on and on.
Does Hydroquinone Cause Cancer
Hydroquinone has been available as active ingredient for over 50 years and there have not been any reported cases of hydroquinone induced cancer in humans. There is also no evidence in human clinical studies to suggest that Hydroquinone could cause cancer in humans. It is suggested that additional studies are needed.
What about the Rats? I have heard and read many times that hydroquinone causes cancer in rats, so I decided to read the study and reviews myself. The 2 year gavage study with hydroquinone, showed some Rats with end stage CPN developed cancer. The problem is that you need to read the full report and it’s reviews before you develop a conclusion. CPN is a renal disease that affects various strain of rats, but has no counterpart in humans. In a 2007 review, McGregor concluded that hydroquinone is carcinogenic only in the context of end-stage CPN, which is not relevant in humans. There is some debate over using rats in carcinogenicity studies, as test results may not be relevant to humans. It should be noted that certain strain of rats are prone to spontaneously develop tumors.
Does Hydroquinone Cause Ochronosis
There are two types of ochronosis, endogenous and exogenous. It is only exogenous ochronosis which can be induced by the topical application of compounds including hydroquinone as well as antimalarias, mercury, resorcinol and phenol. Exogenous ochronosis is a fairly rare type of dermatitis that needs to be diagnosed by a dermatologist. It is not known exactly how hydroquinone induces ochronosis but suggested factors include: sun exposre, long term use of hydroquinone, high concentrations of hydroquinone, other active derivatives and penetrating vehicles such as t-butyl alcohol, mercuric compounds, resorcinol and hydroalcoholic lotion. Exogenous ochronosis is believed to be a progressive disorder that likely develops over several years.
Was Hydroquinone Banned
No, hydroquinone was not “banned” in the US. Hydroquinone is available in concentrations of 2% or less over the counter (OTC), and concentrations over 2% (typically 4%) are available in prescription strength in the United States.
To simply say Hydroquinone has been “banned” in other countries is something of a misrepresentation. First, we need to acknowledge that hydroquinone is an active ingredient available in prescription strength and over the counter (OTC) strength. I am not aware of any ban or proposed ban on prescription strength hydroquinone in any country. The confusion seems to come from the change in availability of over the counter (OTC) hydroquinone. In Japan and Australia hydroquinone is no longer available in cosmetics OTC (over the counter), it is only available as a prescription based ingredient.
As part of a review of OTC products, the FDA published a proposed rule in 2006 to consider the withdraw of the 1982 rule that recommended hydroquinone be GRASE, because of evidence indicating that hydroquinone may act as a carcinogen in rats and mice after oral administration. It is argued that this is not relevant in humans, so the proposed rule recommended additional studies should be conducted to determine if there is a risk to humans. The FDA has yet to make a final ruling, but until then it’s still believed that hydroquinone should remain available as an OTC (over the counter) drug product.
I have considered the facts, studies, reviews and opinions of medical professionals and have concluded that I will continue to use hydroquinone. I would not be concerned if my mom, best friend, husband or children were using hydroquinone. I feel very confidant in the efficacy and safety of hydroquinone. I will continue review and consider any new information and I will modify this post if my opinion changes.
I have read hundreds of pages of studies, reviews, letters and other published literature on the subject of hydroquinone. I am not able to share everything I have learned, but I focused on some of the main points. I have included links to resources that are available on line, I encourage anyone who is concerned about hydroquinone to do thier own homework. I also recommend consulting with your doctor.
If you are using hydroquinone, be sure to use a broad spectrum sunblock and give your skin a resting period from hydroquinone. For example: 3 months on and 3 months off.
There have been reports of counterfeit beauty products and illegally imported skin care products containing mercury. I strongly discourage purchasing skin bleaching creams on-line.
FDA / Hydroquinone Studies Under The National Toxicology Program (NTP)
Nomination Profile /Hydroquinone [CAS 123-31-9] Supporting Information for Toxicological Evaluation by the National Toxicology Program /21 May 2009 / Prepared by U.S. Food & Drug Administration Department of Health and Human Services
Hydroquinone: An Evaluation of the Human Risks from its Carcinogenic and Mutagenic Properties / Critical Reviews in Toxicology 2007, Vol. 37, No. 10 , Pages 887-914 / Douglas McGregor /Toxicity Evaluation Consultants, Aberdour, Scotland, United Kingdom / Toxicity Evaluation Consultants, 38 Shore Road, Aberdour, KY30TU, Scotland, UK
FDA / Rulemaking History for OTC Skin Bleaching Drug Products
Guidance for Industry / S1B Testing for Carcinogenicity of Pharmaceuticals
SALIENT OBSERVATIONS FROM THE PUBLISHED LITERATURE ON EXOGENOUS OCHRONOSIS REPORTEDLY ASSOCIATED
WITH SKIN DISCOLORATION FADE PRODUCTS / May 12, 1992
Levitt J. The safety of hydroquinone: a dermatologist’s response to the 2006 Federal Register. J Am Acad Dermatol. 2007 Apr 26;
The safety of hydroquinone: a dermatologist’s response to the 2006 Federal Register.
Skin Bleaching Drug Products For Over-the-Counter Human Use; Proposed Rule
Rats: Test Results That Don’t Apply to Humans
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Melasma (chloasma) is hyperpigmentation or dark, irregular patches commonly found on the upper cheeks, nose, upper lip, and forehead. The patches can develop gradually over time or during pregnancy. Melasma can also develop when taking oral contraceptives or hormone replacement therapy medications. Melasma is thought to be stimulated by hormones, however exactly which hormones are involved has yet to be determined. The most important factor in the development of melasma is sun exposure,and without the strict avoidance of sun exposure, treatments for melasma are likely to be unsuccessful. Melasma can be permanent or disappear and reappear with each pregnancy.
Hyperpigmentation is the term used to describe any type of abnormal dark area of the skin, this includes melasma, freckles and sun spots. When we treat hyperpigmentation in the skin, it is important to understand that the melanocyte is not functioning properly, so it overproduces melanosomes and the excess melanin can not be evenly distributed among the keratinocytys. As the cells rise to the surface of the skin they cause over pigmented or dark spots. When the skin is exfoliated with AHA’s, chemical peels or microdermabrasion, the hyperpigmentation will appear lighter because some of the top layers of skin have been removed and the pigment is less dense (temporarily). The pigment is still there, it is just appears lighter and the melanocyte is still not functioning properlly, so in a few weeks as the top skin layers are replaced the pigment will appear dark again. Tanning will also further stimulate the melanocyte causing darker pigmentation to develop and Melasma will become worse. Hydroquinone works to suppress the melanocyte and is an excellent way to treat the pregnancy mask. For best results Hydroquinone can be used in conjunction with exfoliating treatments. I understand this description may be a little difficult to understand, so if I have lost you, you can come in for a consultation and I will use visual aids to better explain the cause and treatment for hyperpigmentation.
Melasma: My Personal Story
I have Melasma myself, on my upper cheeks and forehead. I first developed Melasma patches on my upper cheeks in my late twenties and later after giving birth to my second child I developed another large patch in the center of my forehead. I have successfully treated my Melasma, but I need to continue to maintain my skin so that it doesn’t come back. As a Medical Esthetician, I obviously have access to the best skin care products and treatments available. I can share both my professional and personal experience with treating Melasma. Using hydroquinone, and broad spectrum sunblock is absolutely necessary for treating and controlling Melasma. Even after successful correction of Melasma, the hyperpigmentation can reappear especially after sun exposure.
My Personal Skin Regimen
My personal skin regimen includes using the Obagi Nu-Derm system, with a 1/2 gram of Clear (4% hydroquinone) AM and PM. Initially I used a 1/2 gram of a .1% tretinoin ( Retin-A) every night, however I am now on a maintenance protocol and only use tretinoin occasionally. I also use a topical vitamin C and a broad spectrum sunblock containing Zinc oxide. I top it off with Jane Iredale mineral makeup SPF 20.
Professional Skin Treatments
I have had an Obagi Blue Peel, and Fraxel treatments. I personally felt I had better results with the Blue Peel. Fractional laser resurfacing and Blue Peels are ideal when treating deep or resistant Melasma.
Although I have corrected my Melasma, I still need to continue to maintain my skin to keep the Melasma under control. In addition to the topical products I previously mentioned, I try to have a light chemical peel every 4-6 weeks. The chemical peel I have found that gives me the best results treating pigmentation, is a custom chemical peel.
Obagi Nu-Derm System
This is correction after using the Obagi Nu-Derm System. This is a prescription strength skin system and is only available at medical skin clinics. Treatment protocols vary depending on skin type and condition.
Obagi Blue Peel
This is an example of deeply pigmented Melasma.
After treatment with Obagi Nu- Derm & Obagi Blue Peel
It is important to precondition with the Obagi Nu-Derm System and Retin-A before having a Blue Peel. I recommend preconditioning for a minimum of 6 weeks or longer depending on how aggressively Tretinoin is used. Patients that are better preconditioned get a better result. It is also necessary to continue to use the creams after peel to prevent Hyperpigmentation & to maintain healthy skin.
Custom Chemical Peel for Melasma
The Custom Chemical Peel I use is a light peel that can be repeated as often as every 4-6 weeks, compared to the Obagi Blue Peel which is a deeper peel necessary for treating deeper pigmentation. I have decided to not include details of my protocol for this custom peel. It is proprietary information that I don’t wish to share with others in the industry. If you would like to learn more, you can schedule a private consultation. I can tell you that with this peel, I will usually get light peeling for 2-3 days. The peeling is minimal and I would not consider there to be any “down-time”, you can still go about your regular routine. You just don’t want to schedule a peel less than a week before any major event like a wedding. I make it a point to work with my clients and their social calendar, so that they look their best for any events.
Get Professional Treatment For Melasma
If you have Melasma call to schedule a free consultation at
Paradise Valley Skin Klinic.
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