Do I need to stop using hydroquinone (HQ) to treat my hyperpigmentation after 3 months?

Do I need to stop using hydroquinone (HQ) to treat my hyperpigmentation after 3 months?

In short, no.

Hydroquinone (HQ) is a tyrosinase inhibitor and it is the gold standard prescription treatment for unwanted spots of pigmentation on the skin – like sun damage and the dark spots that can appear from an acne lesion, as well as hormonal pigment problems like melasma. Generally, if there is absolutely no improvement in the pigmentation after 3 months of continuous nightly use of a combination HQ and retinoid topical agent then it should be discontinued because it probably will not be beneficial if used longer. 

There are two reasons why popular media like the internet often advise against using HQ containing products for more than 3 months:

First, the most well-recognised side effect of HQ use is a paradoxical increase in pigmentation known as exogenous ochronosis which occurs most commonly on sun-exposed areas of the skin treated with HQ. A review of the literature indicates that this is exceptionally rare and it is estimated that there is one case of exogenous ochronosis for every 300-450 million tubes of HQ sold in the United States. It is also important to note that these cases relate to the use of HQ in high concentrations for a number of years generally in darker skinned individuals.  

Second, the most common prescription preparations of HQ combine it with tretinoin but also with a topical steroid; it is the use of topical steroid for more than 12 weeks which is why in popular literature and the internet patients are warned against using the treatment for more than 12 weeks.  

It is generally very safe to use a HQ-containing topical that is prescribed and use under medical supervision - like via @dermatica.skin – and we don’t often compound our products with topical steroids unless specifically indicated for a patient The concomitant use of daily sunscreen is extremely important to help minimise the risk of worsening the pigmentation during treatment or causing it to recur after successful treatment. If you are seeing improvement in your pigmentation after three months but you still want more improvement, then it is perfectly acceptable to continue using your HQ-containing @Dermatica.skin product for more than three months. Once you have reached your desired improvement in your pigmentation, switching to one of our other tretinoin-based topical treatments combined with daily sunscreen use and sun avoidance will help maintain the improvement in your pigmentation for years to come.