In This Issue:
No, I'm not just feeling argumentative! A very real debate is currently raging as the FDA considers banning hydroquinone, an ingredient that many dermatologists recognize as the preeminent tool for treating excessive skin darkness. This potential ban could affect you more than you realize, so let's take a look at the arguments.
The Pros:
When it comes to treating hyperpigmentation, nothing has proven more effective than hydroquinone. But let's back up: What's hyperpigmentation? Simply put, it's a darkening of the skin, and can refer to anything from freckles to sun damage to the dark marks left behind when a cut or pimple heals. Hormonal changes – from pregnancy, birth control pills, or hormone therapy, for example – can also lead to a more severe form of hyperpigmentation known as melasma. Hydroquinone works by inhibiting tyrosinase, an enzyme that stimulates the production of melanin, or skin pigment – it can decrease its activity by 90% and dramatically reduce excessive darkness.
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The Cons:
The FDA's primary concern is that hydroquinone can lead to a condition called ochronosis, which is basically a more permanent form of hyperpigmentation. Other side effects like skin rashes and nail discoloration may also occur, but can be resolved by simply discontinuing use of hydroquinone. Some researchers have raised concerns about whether hydroquinone and related compounds may cause cancer, but there have been no reported cases of human malignancies resulting from topical application of hydroquinone. As a result of these concerns, hydroquinone is only available by prescription in Europe and it is highly regulated in Asia.
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My Verdict:
GRASE?
What may sound like gibberish is actually a commonly used acronym in the dermatological community. It stands for "generally recognized as safe and effective." That's the status hydroquinone stands to lose if the FDA rules against it. But with a track record of safety and efficacy spanning over forty years, does hydroquinone – and over 200 products that contain it – deserve to lose this classification?
Like many of my colleagues, I firmly believe that an FDA ban on hydroquinone would be detrimental to many of my patients. Despite the widespread presence of hydroquinone, only thirty cases of ochronosis have been attributed to its use in North America; in the ten years I've used hydroquinone in my practice, I have never seen any adverse effects. And while I am well aware of the stress that ochronosis can cause, far more patients stand to suffer from losing this powerful treatment for skin discoloration.
Many members of the dermatological community have questioned the evidence the FDA is using to support a potential ban. For example, studies have shown that huge doses of hydroquinone delivered internally – not by topical application – resulted in some evidence of cancer in rats. However, rats metabolize hydroquinone very differently than humans, who detoxify it in the liver. In the forty years hydroquinone has been on the market, no human cases of cancer have been attributed to its use.
The FDA has raised some valid concerns, and my hope is that we will continue to have access to hydroquinone – and will take this opportunity to use it better. For example, ochronosis is known to occur when hydroquinone is used in concentrations of 4% or greater; the hydroquinone concentration in over-the-counter products, though, is 2% or less. Recent studies have also demonstrated the effectiveness of creams that contain hydroquinone in combination with other ingredients. By paying careful attention to how much hydroquinone we are applying and by using it in four-month cycles (alternating with other skin-lightening products), we can enjoy its benefits while minimizing the risks.
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So, What Will Happen if the FDA Does Ban Hydroquinone?
If the ban goes through – and keep checking my blog at www.skintypesolutions.com/blog/ for the latest dermatology news! – both prescription and over-the-counter products containing hydroquinone could be pulled from shelves by April. In the event of a ban, all hydroquinone-containing products would be considered new drugs and would require years of further testing and formal approval.
There is one product, however, that would remain unaffected by the ban: Tri-Luma. When the FDA solicited safety data on hydroquinone several years ago, only the company that makes Tri-Luma complied. It has now been approved (which speaks to the misguidedness of a hydroquinone ban, in many dermatologists' opinions).
Although I feel that hydroquinone is perfectly safe, many of you have said in the forums at www.skintypesolutions.com/forums that you want to be extra safe and avoid it. There are other options! While hydroquinone is certainly the most talked-about (and effective) skin lightener out there, several other ingredients have also proven effective in treating hyperpigmentation.
The following ingredients work much like hydroquinone, by inhibiting the melanin-producing enzyme tyrosinase:
- Vitamin C (a.k.a. ascorbic acid) – Available in an increasing number of skin care products, vitamin C can be applied topically as a serum (La Roche-Posay Biomedic Potent-C 10.5 Concentrate, for example) or as a powder (I like Philosophy Hope and a Prayer powder).
- Kojic acid and arbutin – These ingredients are ideal for pigmented types who also have sensitive skin. (You can find both in SkinCeuticals Phyto+ and Philosophy's A Pigment of Your Imagination.)
- Licorice extract – Sensitive skin types in particular will also appreciate licorice extract's anti-inflammatory properties. (Try MD Formulations Vit-A-Plus Illuminating Crème for your body – it lightens, moisturizes, and protects you from further damage with SPF 15. For the face I like DDF Brightening Cleanser, which contains both licorice extract and kojic acid.)
The following ingredients work by limiting the
transfer of pigment into your skin cells:
- Soy – Be careful, though, that soy's estrogenic components have been removed. (The easiest way to do that is to look for Aveeno and Neutrogena products.) Many cleansers, moisturizers, and even foundations contain soy, which can help you prevent dark spots before they start.
- Niacinamide – Like licorice extract, niacinamide is also an effective anti-inflammatory ingredient. (You'll find it in Olay Definity and Nia24 skin care products.)
Exfoliating ingredients can also help with hyperpigmentation
by speeding up your skin's natural cell turnover:
- Alpha hydroxy and beta hydroxy acids – Dry or sensitive types, however, should avoid these powerful exfoliating ingredients. (Murad AHA/BHA Exfoliating Cleanser offers the anti-inflammatory benefits of licorice extract too.)
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Find many of these products – or search for other products by skin type – at www.skintypesolutionsstore.com, where a portion of proceeds always goes to The Dermatology Foundation.
Q: Anytime I get a cut, a burn, or even a pimple, it leaves a dark area behind long after it heals. Why is that, and is there anything I can do to speed up the healing process and get even skin back? (asked via www.skintypesolutions.com)
A: Your concern is common among pigmented skin types. In fact, there's even an official name for it: post-inflammatory pigmentation alteration, or PIPA. In many cases, making a few changes to your skin care routine – and sticking with them – can have dramatic results.
First off (and at the risk of sounding like a broken record), be extra vigilant about proper sun protection. Even if you pride yourself in tanning well, remember that sun exposure can lead to a buildup of melanin, thereby worsening dark spots. Regular sunscreen use is a must.
Begin applying a skin-lightening product to dark spots as soon as you notice them. (Check out my book The Skin Type Solution for type-specific recommendations, or talk to your dermatologist about prescription and over-the-counter options). Apply the product to areas of hyperpigmentation only, right after you cleanse and before you apply moisturizer or any other product. Keep this routine up until the dark spots are gone (and if that doesn't happen in 6-8 weeks, consult a dermatologist).
Finally, if you have dry skin, never underestimate the importance of regular moisturizing. When dryness meets pigmentation, patches of darkened skin are a common result – but you can stop the problem before it starts with an appropriate moisturizer (and plenty of it).
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Wishing you great skin!
Sincerely,
Dr. Leslie Baumann
