From the late Michael Jackson to startling recent images of Sammy Sosa, skin color is a loaded issue. And although skin color is often controversial, one thing society seems to agree on is that whatever your skin color, having an even skin tone is a must. The media is filled with images of beautiful, flawless people. Men and women with seemingly perfect complexions are heralded as the standard, the goal. But life happens. The scar from falling off your bike when you were younger becomes less of a battle scar and more of an embarrassment as you get older. Acne scars may be constant reminder of a humiliating time in your life. Increasingly, individuals are finding relief in skin bleaching products that promise to correct uneven skin tone. However, in recent years ingredients in such products have come under fire, leaving many consumers unsure of their safety.
How does skin become uneven?
Human skin color is mostly determined by a pigment known as melanin. Melanin is produced by “melanocytes” which are cells in the skin. An uneven complexion can result from insufficient or excess amounts of melanin. In particular, the overproduction of melanin can lead to hyperpigmentation, which refers to the darkening of areas of skin.
Skin bleaching products frequently use topical corticosteroids, mercurials or hydroquinone (HQ) to lighten the skin. HQ, the active ingredient most commonly used in over the counter preparations of skin lightening creams, works primarily by limiting the production of melanin. An active ingredient refers to the component of the cream that actually causes the desired effect. On the other hand, the inactive ingredients are the parts that are not responsible for the desired effect and instead may aide in application, appearance or smell among other factors. In the US, HQ is available over the counter in concentrations up to 2% and can be obtained by prescription up to a 4% concentration.
Can HQ be harmful?
This question is widely debated. Although HQ can be safely, and effectively used to lighten skin discolorations, there are several widely known side effects including irritant contact dermatitis (seen in up to 70% of patients using HQ) and exogenous ochronosis. Characterized by the bluish black discoloration of the skin, exogenous ochronosis is often considered the most severe side effect and is arguably worse than the initial skin discolorations.
In 1994, the International Journal of Toxicology published the Addendum to the Final Report on the Safety Assessment of Hydroquinone in which they concluded that HQ was safe in concentrations of no more than 1% and should not be used in leave-on products. As a result, the European Union, France and some Asian and African countries banned products containing HQ.
Although still legal in the US, HQ has long been on the FDA’s radar. In 1982 the FDA proposed that over the counter creams with concentrations of HQ up to 2% were generally recognized as safe and effective (GRASE). However, in 2006, after tests in animals suggested that orally ingested HQ could cause cancer, the FDA proposed to withdraw HQ’s classification as GRASE until further studies could be done. Currently, the matter is being investigated by the National Toxicology Program with proposed studies to examine: metabolic effects of HQ from both oral ingestion and through the skin, effects on reproduction from oral consumption, and potential to cause cancer from absorption through the skin.
How worried should I be about hydroquinone?
The FDA stated that one major benefit of removing HQ from the market is the reduction in cases of exogenous ochronosis every year. This then begs the question, just how common are cases of exogenous ochronosis? The answer is not very. In fact, there have been a total of 789 cases of ochronosis in the world, with only 22 of those cases occurring in the US from 1983-2006. This is despite an estimated 15 million tubes of bleaching creams containing hydroquinone that are sold each year.
Of the cases that occurred in the US, 21 resulted from the use of HQ up to a 2% concentration, and one case resulted from a 4% concentration. Two cases resulted from a usage duration of 3 months, all other cases reported a duration of at least a year.
What does this all mean?
The decision to lighten your skin is a personal one and can be chosen for many different reasons. Although society often and perhaps vainly correlates even skin tone to a higher level of beauty, the psychological effects of an uneven complexion should not be minimized. Skin lightening creams can increase the psychological well being of both men and women, however there can be danger in starting a skin bleaching regimen on your own. Current literature and legislation regarding the safety of HQ is conflicting and therefore further research is needed to truly determine the effects of hydroquinone on humans. In the meantime, if you choose to use a skin bleaching cream to alter your complexion, be sure to consult a physician, use a reputable product, and adhere strictly to physician orders and the product instructions. On the other hand, although sometimes more difficult to come by, self-confidence is a cheaper, safer alternative to bleaching creams that works every time.
Ladizinski, B., Mistry, N., & Kundu, R. (2011). Widespread Use of Toxic Skin Lightening Compounds: Medical and Psychosocial Aspects. Dermatologic Clinics 29(1).
Levitt, J. (2007). The safety of hydroquinone: A dermatologist’s response to the 2006 Federal Register. Journal of the American Academy of Dermatology 57(5) 854-872.