Hydroquinone: a guide to topical pigment treatment

Hydroquinone is a topical medicine that can reduce melanin production in selected areas of uneven pigmentation. Melanin is the pigment that contributes to skin colour. A clinician may use hydroquinone as part of a plan for persistent dark marks or patches after confirming the likely cause and checking whether the area has changed in a concerning way.

The medicine interferes with a step involved in melanin formation. It is usually applied only to the affected skin, rather than as an all-over skin-lightening product. Results depend on the pigment pattern, ongoing sun exposure, irritation, and how consistently the prescribed plan can be followed. New pigment can continue to form if the triggering factor remains.

Hydroquinone may be prescribed for areas of hyperpigmentation, such as dark marks left after inflammation or patches linked to sun exposure or hormonal change. It is generally used on intact skin. The face can be especially prone to irritation from strong or overlapping products, so a clinician may tailor the amount used and the application schedule.

Depending on the diagnosis, a plan may instead focus on sun protection, stopping an irritating trigger, or another topical medicine. Procedures for pigmentation are sometimes considered, but active inflammation and recent tanning can affect the choice. A new, rapidly changing, bleeding, or irregular pigmented lesion should be assessed medically before any lightening treatment is used.

Follow the prescribed application instructions and avoid spreading the medicine beyond the intended area. Let the prescriber know if you are pregnant, breastfeeding, planning pregnancy, or using other medicated creams. Stinging, dryness, redness, or peeling can signal irritation. Pause treatment and contact the prescriber for troublesome skin reactions, or if the treated area develops an unusual blue-grey or darkened appearance.

Hydroquinone is commonly used for a defined clinician-guided course, with review of both benefit and skin tolerance. Stopping the medicine does not remove the need for daily sun protection because pigment may recur. Prolonged or inappropriate use has been associated with exogenous ochronosis, a difficult blue-grey discolouration. This is one reason to avoid self-directed long-term use and obtain review if colour changes unexpectedly.