Q: I’m wary of using hydroquinone because I heard it was dangerous, but do OTC skin lighteners work?
A: “Four percent hydroquinone is still the gold standard prescription for hyperpigmentation, but it can be irritating,” says San Antonio, Texas, dermatologist Dr. Vivian Bucay, “and, paradoxically, it has been known to cause ochronosis, or darkening of the skin. This is usually the result of unsupervised use of some unapproved hydroquinone.” (As for any carcinogenic risk associated with topical hydroquinone, most U.S. derms agree that this is overblown.)
There are also several other over-the-counter pigment-faders out there, containing botanical ingredients such as licorice root, mulberry, soy extracts, kojic acid, azeliac acid, vitamin C, niacinamide, or arbutin. Like hydroquinone, these work either by blocking pigment production or inhibiting the transfer of melanin to the epidermis.
“Natural lightening ingredients in OTC cosmetics are milder and less potent than prescription-strength hydroquinone, so the results won’t be as rapid or dramatic. And be aware that since the FDA doesn’t regulate them, it’s impossible to know how much of the pigment-inhibiting ingredient is in there.” A good gauge is how close it is to the top of the ingredients list on the package.
One ingredient, the enzyme lignin peroxidase (trademarked as Melanozyme in Elure Advanced Lightening Lotion) is proven to actually break down existing melanin on the surface of the skin. “It works by dissolving surface spots as opposed to blocking pigment production, but clinical studies indicate that it has skin-lightening efficacy similar to 2 percent hydroquinone, the amount found in OTC products." Whichever pigment fighter (or arsenal of a few) you choose, don’t forget one important thing: “All bets are off if you’re not using sunscreen every day vigilantly,” Bucay stresses. That’s how you got those sun spots in the first place.