What is the best hydroquinone skin “bleaching” cream for melasma, acne and sun damage?
So-called “bleaching creams” are causing a lot of confusion among those of you who are loving and taking care of your skin. Hydroquinones being one of them. Here are the 3 main points of confusion.
- None of any these creams actually “bleach” the skin;
- Hydroquinones are the gold standard (the most effective), but are regulated in the U.S. and Europe, not so much elsewhere. How do you choose one?
- These “bleaching” creams can CAUSE irritation, which then makes the pigment worse.
If bleaching creams don’t “bleach,” what are they doing?
- All “bleaching” (let’s call them lightening creams) work by interfering with the way pigment is made in the skin. Cells called melanocytes make melanin which is the extra brown blotches. To make a long story short, something stimulates these cells and there is a chemical process in the cell itself or outside the cell where the cream ingredients bind. When they bind, the pigment machinery in the cell can’t work. What activates these cells? It’s usually sun, irritation on the skin like a rash or an irritating skin care product, or acne. Hormones can also cause the pigment machinery to get too active – like pregnancy or birth control pills/oral contraceptives.
What is the best hydroquinone?
- This depends on the reason for your blotchy pigment and your skin type. See the answer below too because many people get irritated with hydroquinones. This will make the problem worse. Most hydroquinone creams in the drugstore or department store products are 2.0%. This is a safe level for most people, but it’s also not that effective. Doctors in many countries can write prescriptions for hydroquinone 4%, but doctors can also ask a pharmacy to compound (custom mix) a stronger hydroquinone cream. In parts of Africa, Asia and South America, high percentages can be obtained and are not regulated. This can lead to something called ochronosis which makes the problem worse!
- In general, a 4.0% hydroquinone cream will be effective over a 3-6 month period, when used with an 15%-20% zinc sunscreen every morning and hats. If you are getting worse, it means the cream is irritating you. Stop the cream and call your doctor! Do not use strengths greater than 4.0% for any more than 6 months without medical supervision please.
How to recognize irritation from hydroquinone creams.
- You are noticing stinging or burning when you apply it;
- You are not seeing any improvement after a month, OR the brown blotches are getting WORSE. Assuming sun protection;
- Your skin is becoming increasingly red;
- You are noticing very subtle flaking or dryness that isn’t normal for you;
- You are noticing hives or a rash.
If any of the above occur, STOP the cream and call your doctor to help you, if the reaction is severe or persistent.
For more information, see the below topics:
Hope this helps, Dr. I