Treating Hyperpigmentation Without Hydroquinone

Farhaad Riyaz
October 18, 2021

Hydroquinone works by blocking the synthesis of melanin so the treated skin is prevented from producing more pigment

The ingredient hydroquinone is a commonly prescribed lightening agent to help those affected by skin discoloration, otherwise known as hyperpigmentation.  

Hydroquinone works by blocking the synthesis of melanin so the treated skin is prevented from producing more pigment. Its main claim to fame is that it is very effective at lightening skin. I prescribe hydroquinone to 92-95% of patients who come to me with hyperpigmentation because it works well, and most people don’t have problems when using it.  

But occasionally there are reasons that some patients may want to avoid hydroquinone, either for periods of time or altogether. And, continuous hydroquinone use is not recommended, as its overuse is uncommonly associated with development of a bluish-black discoloration called ochronosis. Dermatologists therefore recommend that hydroquinone users take breaks and are likely to prescribe alternatives to use during those breaks.  

Other treatments designed to lighten skin or at least prevent its discoloration are available and can be used on their own or in alternation with hydroquinone treatment. If you do opt for an alternative ingredient, be patient. With hydroquinone, patients can expect to see results within one - two months, but other treatment options are gentler and may take longer to show their results. While hydroquinone works by blocking melanin, most alternatives are designed to decrease inflammation that increases pigments in the skin. Some hydroquinone-free products function better to maintain treatment success than to make further progress on reducing pigmentation.  

Alternatives to hydroquinone

What alternatives to hydroquinone can you use to help with hyperpigmentation? Here is your guide to hydroquinone-free ingredients and products.  

Acids: Kojic acid, tranexamic acid, and azelaic acid

These three acids are gentle topical treatments that are commonly prescribed for use during breaks in hydroquinone treatment. Kojic acid has skin-lightening, anti-aging, and antimicrobial properties. It is derived from mushrooms, so it can cause an allergy in those who are allergic to penicillin. Taken orally, tranexamic acid works well but can increase the risk of blood clots, especially in smokers, pregnant women, and those with a family history or clotting condition. It is often used topically, where there is not risk of blood clotting. Azaleic acid is derived from wheat, rye, barley, or a fungus that is widely found on human skin. It can sometimes cause irritation and dryness but is safe to use all the way through pregnancy.

Retinoids: Tretinoin, tazarotene, adapalene  

Retinoids are compounds derived from vitamin A. They regulate epithelial cell growth and are touted for their anti-aging effects, along with anti-darkening properties. These lighten by giving a gentle peel to the skin. Commonly used retinoids are tretinoin, known by the brand name Retin-A and typically used to treat acne; tazarotene, which is often used to treat acne and psoriasis; and adapalene, which is available over-the-counter.  

Chemical peels: glycolic acid, mandelic acid, trichloroacetic acid  

Chemical peels function by removing dead skin cells and spurring new skin cell growth. Three common ingredients in chemical peels are glycolic acid, a water-soluble alpha hydroxy acid that comes from sugar cane; mandelic acid, an alpha hydroxy acid derived from bitter almonds; and trichloroacetic acid, which has similar molecular structure to acetic acid.

Vitamins: Niacinamide, Vitamin C

A couple types of vitamins can be used to reduce inflammation, which might lighten the skin or at least stave off darkening. One of these is the vitamin niacinamide, which is an additive ingredient that brings down inflammation. Another is Vitamin C, which might also reduce pigmentation through an unknown mechanism.

Combinations

Dermatologists can combine medications to help patients gain more success; patients can use as many of these options as they can tolerate. An example of a combination cream is one that combines phytic acid, tranexamic acid, niacinamide, and tetrapeptide-30.

Combining with hydroquinone

Some products or compounded prescriptions may combine hydroquinone with other ingredients that are listed above. A treatment for melasma might contain a high concentration of hydroquinone, such as 12%, along with a retinoid like tretinoin.  

Most pharmacies do not can create custom formulations of dermatology creams – only compounding pharmacies can do that. Docent’s pharmacy can mix up a particular compound, whether it contains hydroquinone or not.  

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