Hydroquinone alternatives not as effective for skin lightening, expert says

Key Points

Boca Raton, Fla. - Big on promises and a little short on delivery. That's the way Marta Rendon, M.D., would describe most of the skin-lightening therapies proffered as alternatives to hydroquinone.

She says it's not that the herbal compounds currently being touted as safer alternatives to hydroquinone don't work at all, but, she says, they don't work nearly as well.

Combined effort

Dr. Rendon points out that in many of the products being marketed, multiple ingredients are combined to obtain better results.

"The manufacturer will use kojic acid, lactic acid, arbutin and vitamin C, and it might be an OK product. They do help; the ingredients have some lightening properties. But if you were to grade the final product as fair, good or excellent, they would not rate as excellent," she says.

Although a number of over-the-counter (OTC) products contain some promising skin-lightening properties, according to Dr. Rendon, she says the data substantiating the claims is limited.

"Some of the soy protein and soy derivatives have skin-lightening properties. There is variability in the formulations, as there are several companies manufacturing products containing soy," she says.

"Another compound being used in OTC skin-lightening products is niacinamide. We know that as vitamin B3, some studies show that it does inhibit melanosome transfer, improving pigment transfer from melanocytes to keratinocytes."

Dr. Rendon also looked at emblica, which is said to affect melanin synthesis and is an antioxidant.

"All of these ingredients have literature showing they are somewhat effective in lightening skin. The problem is that if you look at most of the studies, they include small patient samples with as few as 10 or 20 people, so you can't really make a strong statement on their validity as pure skin-lightening agents, although they might have other skin benefits."

Results with glycolic acid and retinoids show promise, Dr. Rendon says, but she attributes that to their ability to increase exfoliation. Retinoids also can help with melanosome transfer.

Hydroquinone concerns

Dr. Rendon says she believes people have been seeking a hydroquinone substitute due to its reputed side effects, but she thinks that rationale lacks substance.

"One of the concerns is that hydroquinone is listed as a potential carcinogen, but we don't believe that's true," she says. "We have used so many hundreds of thousands of pounds of hydroquinone, since at least the 1970s, that if hydroquinone were truly a carcinogen, we would have seen the damaging effects by now."

She says hydroquinone can have side effects, but serious complications are rare.

"One of the dreaded side effects of hydroquinone is ochronosis; the bluish, dark pigmentation around the eyes," Dr. Rendon says. "Looking at the data, it's not really dependent on the percentage of hydroquinone used, but more as an independent reactivity a patient might have. The issue is that it can happen with any strength of hydroquinone, not just prescription strength. I have seen only one case in my whole 19-year career."