Medically reviewed by Joni Gunzburger, MSN, FNP-C on November 10, 2022
Tired of those dark spots and patches dialing down your glow? If your hyperpigmentation is caused by melasma? you might want to consider hydroquinone cream. It’s a skin-brightening prescription treatment that’s more potent than over-the-counter products containing ingredients like vitamin C. Hydroquinone topical creams are the most clinically effective treatment for melasma, and are sometimes prescribed for sun spots and post-inflammatory hyperpigmentation from acne.
Is hydroquinone right for you? Let’s take a closer look at this medication to see if you should add it to your skin care routine.
How Hydroquinone Works
Hydroquinone cream prevents the melanocytes in your skin from producing melanin. Melanin is the skin’s main pigment, so by reducing it in your trouble areas, you can also reduce dark spots and hyperpigmentation. You may hear hydroquinone called a skin bleaching agent, but it doesn’t bleach the skin.
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How Many Times a Day Can You Use Hydroquinone?
Most doctors recommend using hydroquinone twice a day — likely when you wash your face in the morning and at night. Regular application is the best way to improve your skin tone and reduce hyperpigmentation.
What Results Can Someone See When Using Hydroquinone?
You’ll begin to see your skin tone leveling out and dark patches fading after around four weeks. By the third month of application, your dark spots should be greatly reduced. Many patients report being much more satisfied with their appearance and confident in their skin after a three-month course of hydroquinone.
Your results may be even better if you pair hydroquinone with other skin-brightening agents such as vitamin C or kojic acid. Hydroquinone is prescription-only, so when using it you should consult with the medical provider who prescribed it before adding otherskin care products to your routine.
Another way to improve results is to limit your sun exposure. UV light can trigger the production of melanin, which is what hydroquinone is trying to stop! Too much sun will work against you and make melasma worse.
How Does Hydroquinone Target Dark Spots?
The mechanism of action of hydroquinone is a bit complex. It prevents an amino acid called L-3,4- dihydroxyphenylalanine (L-DOPA) from being converted into melanin by inhibiting an enzyme called tyrosinase. Tyrosinase converts L-DOPA into melanin, so without it, your skin can’t produce this pigment. Over time, this means your melasma and other dark spots will lighten up.
Just keep in mind — hydroquinone just targets dark spots. It won’t battle any other skin issues or signs of aging. For that, we recommend checking out some of our other anti aging medications.
Best Uses for Hydroquinone
Hydroquinone therapy treats skin conditions like acne scars, age spots, freckles, melasma, and post-inflammatory hyperpigmentation from eczema or psoriasis. That said, it won’t work for active redness or inflammation from acne.
Can You Use Hydroquinone Every Day, Why or Why Not?
Yes, to see the best skin-brightening results, you should use hydroquinone cream every day! If you’re not consistent with your application, it may take longer for you to see a difference — if you see one at all.
Hydroquinone will only inhibit the production of melanin while it’s actively in the skin, so reapplying is the best way to keep the depigmentation process going so you see a reduction in hyperpigmentation and dark spots.
However, most medical providers recommend you use hydroquinone for no longer than 3-6 months, because with prolonged use it can actually make dark patches worse. Your medical provider may prescribe you a three month dose of hydroquinone, then switch you to other medications like azelaic acid or tretinoin to maintain your results.
What Can You Not Mix With Hydroquinone?
The great news is that hydroquinone is safe to integrate into your existing skin care routine. Just watch out for products containing benzoyl peroxide or hydrogen peroxide as well as alpha hydroxy acids. The combo of these can irritate your skin or even cause temporary staining.
Why Would Someone Begin to Use Hydroquinone?
Usually, a patient using hydroquinone cream has tried over-the-counter skin brightening products to no avail. For example, they may have tried kojic acid and vitamin C and didn’t see any changes to their dark spots or skin tone. Since hydroquinone is prescription strength, it’s more potent and effective than over-the-counter treatments at solving hard-to-treat melasma hyperpigmentation and dark patches.
A common dose to start with is 4% hydroquinone cream, though there are stronger prescriptions available if your doctor thinks they’re a good choice for you.
Efficacy of Hydroquinone
Numerous studies have found that hydroquinone cream is effective at reducing hyperpigmentation. In one study published in the J Eur Acad Dermatol Venereol, 79% of patients using 4% hydroquinone as a melasma treatment saw an improvement in their skin tone.
Another study published in the Iranian Journal of Dermatology that looked at hydroquinone 5% cream plus azelaic acid 20% found patients saw a remarkable improvement in their melasma area.
What Other Drugs Interact With Hydroquinone?
Luckily, doctors haven’t found any serious drug interactions with hydroquinone, meaning you shouldn’t have to cease taking any medications. Of course, your doctor will have more info about potential interactions in your specific situation.
Though it’s not a drug, the sun can have unfortunate interactions with topical hydroquinone. Too much sun stimulates your body to produce more melanin, which could cancel out the results of your hydroquinone treatment. To avoid this, we recommend using sun protection every time you’ll be outside. Try at least SPF 30 sunscreen, wear a hat that shades your face, and stick to the shade during the mid-day hours when the sun is its harshest.
How Quickly Can Someone Expect to See Results From Using Hydroquinone?
It usually takes about four weeks to start seeing results from hydroquinone topical cream. These results should continue to improve until three months after you’ve started treatment. At that point, most doctors recommend taking a six-to-nine month break to give your melanocytes a chance to stabilize before continuing treatment.
When Should You Stop Using Hydroquinone?
There are a few times you should stop using hydroquinone. The first and most serious is if you’re having severe side effects from the cream. Ideally, the first time you’re using hydroquinone cream, you should do a skin test by rubbing some of the product on your skin and waiting 24 hours to see if you have a reaction. If you experience severe itching or irritation, discontinue use and let your doctor know.
However, medical guidelines specify that you should stop using hydroquinone if you haven’t seen any results after about three months. Your doctor may recommend you try some new products that combine hydroquinone with other ingredients, such as glycolic acid. They may also recommend switching to tranexamic acid, which is a newer cream that has comparable results to hydroquinone in reducing hyperpigmentation.
Precautions for Using Hydroquinone
The good news is that hydroquinone topical cream is relatively safe for your skin — in fact, scientists haven’t found any evidence that it’s harmful. However, you might still get some adverse effects, such as skin irritation, including red and dry skin where you apply it. As long as you’re using a doctor-prescribed hydroquinone cream, you can avoid many of the skin lightening dangers patients see in over-the-counter, non-FDA-approved products.
What Should You Know Before Using Hydroquinone?
There is one more serious condition that hydroquinone can cause. It’s called ochronosis, and it’s characterized by areas of gray-blue or blue-black discoloration that are hard to treat or even permanent. Typically, this only happens when you use hydroquinone for too long, so as long as you follow your doctor’s instructions, you should be safe.
Also, if you’re planning to get pregnant or are currently pregnant or breastfeeding, you should wait to take hydroquinone. While current research hasn’t shown any links between birth defects or pregnancy complications, doctors aren’t quite sure how it reacts with babies. Because your body absorbs a substantial amount of the drug (35% to 45%), it’s best to avoid it until further research can be done.
How Long Is It Safe to Use Hydroquinone?
Doctors generally agree that it’s safe to use hydroquinone for skin brightening for about three months. After that, you run the risk of developing ochronosis. If you find that your hyperpigmentation is starting to return, your doctor might give you the go-ahead to resume hydroquinone 4% cream after a break of six months. There are also other treatments you can try if you want to address your acne scars, hyperpigmentation, and dark spots.
What Health Conditions May Interact With Hydroquinone?
Hydroquinone doesn’t have any serious reactions with other health conditions. That said, you should let your doctor know if you have another skin condition, such as eczema, psoriasis, or sensitive skin.
You should also tell your doctor if you have asthma. While you likely won’t be inhaling hydroquinone, it can have serious effects if it gets into your lungs.
If you’re interested in adding hydroquinone to your skincare routine, get started here by filling out a skincare questionnaire.