News: Beware of Hydroquinone

One to digest for the day – it might be wordy but mush on through for beauty warfare! 

This chemical hydroquinone can cause dark bluish patches on your skin and permanently disfigure it. It’s like a new-age eyebrow tattoo gone wrong.  Thankfully it’s mostly only in prescription medicine. But still, it’ll be good to double check your product list from now on.

Taken from the Straits Times, 26 April. 

THE DARK SIDE TO SKIN-LIGHTENING CREAMS by Ng Wan Ching

Women using whitening products may be unknowingly making themselves vulnerable to a disfiguring and difficult-to-treat skin condition called exogenous ochronosis, in which the skin turns a bluish-black.

 It is caused by hydroquinone, a powerful whitening ingredient available here in prescription-only products.

General practitioner Tan Siak Khim worries that women will continue to use these products and doctors will continue to prescribe them without realising the risk.

In a study of 38 patients seen for pigmentation problems at his clinic, The DRx Clinic, between 2006 and 2010, he found 13 of them suffering from exogenous ochronosis.

All ethnic Chinese women aged between 38 and 68, the patients had used whitening products containing hydroquinone for at least two years.

The products used included a triple combination cream containing hydroquinone, tretinoin and fluocinolone, a lightening cream containing 4 per cent hydroquinone and a skin-lightening cream developed by a local tertiary dermatology facility containing 4 per cent hydroquinone.

The study was published in the Journal Of The European Academy Of Dermatology And Venereology in July last year.

Since his study was done, Dr Tan has diagnosed another 17 women with exogenous ochronosis, bringing the total seen in his clinic to 30.

He is worried that this is just the tip of the iceberg and that this could be a huge, under-reported problem, given how lucrative the skin-whitening industry is. In Singapore, beauty-industry players estimated the mass market for skin-whitening products to be worth about $11.5 million a year in 2007.

Hydroquinone is used as a bleaching agent in many products to treat pigment problems such as melasma, the discolouration in skin caused by factors such as hormonal changes and sun exposure.

But research shows that the continual and chronic use of hydroquinone, even in low concentrations of 2 per cent, also causes the skin to discolour.

In fact, women may worsen the problem by continuing to use hydroquinone products when they see no improvement in their original condition.

Dr Steven Thng, a consultant dermatologist at the National Skin Centre (NSC), said hydroquinone, which is a very common ingredient found in common bleaching creams and is prescribed for melasma, causes and worsens exogenous ochronosis.

But no one knows how many users of hydroquinone will go on to develop exogenous ochronosis, he added.

The NSC treated 1,199 people with melasma in 2010 and 1,301 last year.

Dr Wong Su-Ni, a consultant dermatologist and president of the Dermatological Society of Singapore, said the condition may be under-diagnosed because the only way to accurately diagnose it is to perform a skin biopsy – testing a sample of the tissue – and many patients ‘would baulk at the thought of having a biopsy scar on the face’.

It is difficult to ascertain simply by looking at the discolouration if the condition stems from hydroquinone use, an allergy or irritation to unknown ingredients, or the melasma itself worsening, she said.

Furthermore, many patients doctor-hop and doctors tend not to clearly label the ingredients of the creams or skincare products prescribed on their own packaging, she added.

On a positive note, she said only a very small number of people develop exogenous ochronosis. But she advised women to consult a dermatologist if they were in doubt and to be judicious in buying products.

She said: ‘Skin-whitening products bought over-the-counter are used at your own risk. Although these are generally mild and well-tolerated, some individuals with sensitive skin may still develop irritation or allergy.’

Consumers should be careful of re-packaged creams which do not state clearly the active ingredients, and always ask about the concentration of hydroquinone, she advised.

The Health Sciences Authority (HSA) said products containing hydroquinone have been licensed as medicinal products since January 2008. All hydroquinone-containing products are subject to pre-market approval by HSA and a product licence under the Medicines Act is required for the legal sale and supply of the products.

All hydroquinone products registered locally are available at strengths higher than 2 per cent and are available only with a prescription, said the HSA.

Hydroquinone is not allowed in skin-whitening cosmetic products that are available over the counter, a move that has been adopted across Asean countries because of concerns that inappropriate and widespread use of hydroquinone may lead to adverse health effects. A similar position has also been taken by the United States and the European Union.

Exogenous ochronosis is now a foremost consideration in the diagnosis and treatment of pigmentation in Dr Tan’s clinic.

One patient, Madam Ho Nyuk Fah, said startling blue-black dots first popped up on the sides of her face about 10 years ago, after she used hydroquinone cream to whiten her skin.

The dots grew and darkened. As they threatened to encroach further on her face, Madam Ho used skin-whitening creams in a desperate attempt to halt their march.

Little did she know she was doing the worst possible thing.

Now 60 years old, the school canteen assistant went from doctor to doctor seeking to get rid of the unsightly patches on her face.

‘Nothing made it better. I kept putting creams on my face and it just kept getting worse,’ Madam Ho said. ‘I am quite vain and it upset me terribly to see my face like that.’

In 2006, she met Dr Tan, who told her to stop using the creams, which contained hydroquinone.

He did a skin biopsy as he suspected what she had was not melasma. He was right.

She had exogenous ochronosis, characterised by the coarsening and darkening of her skin.

She went through more than 25 sessions of laser treatment and no hydroquinone was prescribed.

Her condition after laser treatment was much better, said Dr Tan.

‘Asian women have always equated fairness with beauty. This long ingrained belief, reinforced through generations of indoctrination, has made it a mindset that is beyond doctors to change. The best we can do is alert users of skin-lightening products of any associated side effects, some of which may potentially be permanent,’ he said.

Treating blotches

MELASMA

A common pigmentation problem affecting Asians, it usually appears as brown patches over the cheeks, although the forehead, temples, nasal bridge, upper lips and jaw line may be affected as well.

Melasma is the result of various genetic, hormonal or environmental factors.

Women are more commonly affected and report worse symptoms after sun exposure, pregnancy and the use of oral contraceptives.

Melasma is challenging to treat as it usually recurs. Prevention is the most effective strategy, so it is best controlled with the regular use of sunscreen, lightening creams and general avoidance of the sun.

For difficult cases, chemical peeling, intense pulsed light therapy and certain types of laser treatment may offer additional benefits but the results may vary.

EXOGENOUS OCHRONOSIS

It is an often permanent discolouration of the skin which occurs as a result of prolonged use of skincare products containing hydroquinone.

There is currently no reported effective treatment for it. Various treatments have been tried, including dermabrasion, chemical peels and laser resurfacing, with little improvement.

However, reports of successful treatment with some lasers are encouraging and it remains to be seen whether laser therapy will be the answer to this recalcitrant condition.

Patients should seek medical attention and use sunscreen.

Preventing blotches

The pigment melanin is produced by the skin to protect it from the sun. It is also what causes skin to darken.

You can discourage melanin production in the following ways:

  • Always wear sunscreen.
  • Wear clothing that protects you from the sun.
  • Stay in the shade during periods of intense sunlight.
  • Eat lots of fruit and vegetables. Vitamins A, C and E keep your skin conditioned, and you can get these from green leafy vegetables, bright red and yellow fruits and vegetables, and whole grains and nuts.
  • Drinking a lot of water keeps your skin hydrated and encourages healthy circulation.
  • Gently exfoliate and moisturise your skin every day.
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