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Pharmacy and Medications

Is Hydroquinone safe (Facial cream)

05/03/2005

Question:

Is it safe to use Esoterica? It fades my blemishes and my freckles!

Answer:

Esoterica® is one of several brand products containing the active ingredient hydroquinone. Hydroquinone is used to gradually fade hyperpigmented skin. Hyperpigmented skin refers to freckles, age spots and any other conditions where an area of the skin is darker in color compared to the surrounding area.
 
Skin gets its color from a substance called melanin. The darker one's skin, the more melanin it contains. Exposure to the sun causes melanin production.
 
Hydroquinone works by causing loss of melanin from skin cells and may also inhibit the production of melanin essentially having a bleaching effect on the skin.

Since sun exposure increases melanin production, it is suggested that sunscreen or sunblock be applied along with hydroquinone to prevent darkening of the skin again. Hydroquinone itself should not be used for sunburn prevention. Many of the hydroquinone-containing products also contain a sunscreen product.

The safety of hydroquinone is based upon proper use of the medication. Hydroquinone cream or gel is for external use only. A thin layer is applied usually twice daily, in the morning and before bedtime, or as directed by a physician. Application of the product should be limited to an area equal to that of the face and neck or hands and arms. It should not be used near the eyes.

These products should also not be used on irritated, damaged or sunburned skin. When the affected area has faded to the desired degree, hydroquinone should be applied only as often as needed to maintain that desired effect. The effect usually lasts for 2-6 months after stopping use of the hydroquinone.
 
Safety has not been established in children younger than 12 years of age. People with sulfite allergy should read the label carefully as some of these products such as Esoterica® contain sodium bisulfite or sodium metabisulfite.

If no bleaching or lightening effect is noted after 2 months of use (or 3 months if using the 2 % cream), stop treatment with the hydroquinone.

The most commonly reported side effect is mild skin irritation, such as burning or stinging. Rarely, a blue-black darkening of the skin may occur. Should this happen, the product should be discontinued, and a physician contacted.

Hydroquinone is in Pregnancy Category C. No studies in animals have been performed using this medication thus it is not known whether hydroquinone causes damage to an unborn fetus when applied to the skin. A physician should be consulted in the case of pregnancy as use of this product should only be done if clearly needed. It should also be used with caution in nursing women as it is not known whether hydroquinone is absorbed into breast milk.

Susan Kuo, Pharm.D Candidate, University of Cincinnati

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati

Jan Scaglione, MT, PharmD, D.ABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati