HYDROQUINONE IN COSMETIC PRODUCTS ASSOCIATED WITH SKIN

DISORDERS AMONG ASIAN WOMEN

H.Ardiyan Boer
Bagian Anatomi
Fakultas Kedokteran Usakti

ABSTRACT
Over 40 years hydroquinone has been used as the agent of skin-lightening cream and it was
considered safe for the consumers. However, after many outbreaks from around the world about
its side effects to the skin this lightening agent had been banned recently. Studies had found some
serious dermal effects underlying hydroquinone topical use. Reported cases suggesting that skin
lightening creams containing 2% hydroquinone have produced leucoderma, as well as exogenous
ochronosis. Meanwhile, 1% aqueous solution or 5% hydroquinone cream has caused irritation
such as erythema or staining. Besides, there were cases of brown nail discoloration and allergic
contact dermatitis reported after using hydroquinone. Research on toxicology and biochemistry
of hydroquinone were conducted and the results proved the adverse effects of this reagent to the
human skin.
Key-word, Hydroquinone, consumers, side effects to the human skin, serious dermal
effects.
Abstrak
Lebih 40 tahun yang lalu, Hydroquinone sudah digunakan sebagai bahan obat didalam zalfkulit/krem, dan bahan / krem tersebut aman / baik untuk konsumen. Tetapi sesudah banyak
keluhan keluhan yang muncul di seluruh dunia tentang efek sampingnya pada kulit, maka
bahan tersebut langsung dilarang beredar. Beberapa penelitian atau studi menemukan beberapa
efek / akibat yang serius pada kulit yang memakai hydroquinore secara topical.
Dilaporkan bahwa krem kulit yang mengandung / berisis hydroquinone 2% menyebabkan
leucoderma, seperti exogenous ochronosis. Sedangkan 1% larutan encer atau 5% krem
hydroquinone dapat menyebabkan iritasi seperti erythema atau noda. Di samping itu, ada
beberapa kasus dengan kelainan warna kuku coklat dan dermatitis alergi kontak dilaporkan
sesudah pemakaian hydroquinone. Penelitian tentang toxikologi dan biokimia hydroquinone
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sudah dikerjakan dan hasilnya membuktikan bahwa ada efek / akibat dari hydroquinone pada
kulit manusia.
Kata kunci : Hydroquinone, pemakai, komplikasi kulit manusia, efek serius kulit manusia
INTRODUCTION
Nowadays, a growing market of skin lightening cosmetics has increased the demand of
these products especially in Asia. Asian women usually seek for any cosmetic products that
could make them look fairer in a short time. Due to this demand, hydroquinone is famously
being used in cosmetics over 40 years and it has been known as the most effective skin
lightening agent. However, not all consumers are aware about its effects on their skin. A
literature search focusing on the biochemistry and toxicology of hydroquinone and related
molecules had been conducted. Researchers found that the long-term use of topical
hydroquinone did pose an increased risk of skin damaged and even cancer, and they
recommended that this benzene derivative no longer be used as a skin-lightening agent. Research
also found about the effects of intermediate use of hydroquinone, such as leucoderma, exogenous
ochronosis, allergic contact dermatitis and nail discolaration. Therefore, Hydroquinone was
finally banned in the local markets.
Hydroquinone
Hydroquinone is 1,4-benzenediol and structurally related to monobenzone. Hydroquinone
occurs as fine, white needles. The drug is freely soluble in water and in alcohol and has a pKa of
9.96. Chemically, hydroquinone is designated as p-dihydroxybenzene; the empirical formula is
C6H6O2and its molecular weight is 110.0.6
The structural formula is :

HO

HO

Molecular formula, as shown below : C6H6O2

Synonyms of hydroquinone are alpha- hydroquinone, hydroquinol, quinol, benzoquinol,

p-benzenediol, 1,4-benzenediol, p-dihydroxybenzene, p-hydroxyphenol, p-dioxobenzene, 1,4dihydroxybenzene, dihydroquinone, pyrogentistic acid, quinnone, aida, arctuvin, eldoquin,
eldopaque, phiaquin, tecquinol, tenox HQ, tequinol.6
Hydroquinone is a toxic reagent that could harm aquatic organism and the environment.
Thus, the labels below could be found in any products or reagent that contain hydroquinone.

Hydroquinone has a variety of uses principally associated with its action as a reducing
agent which is soluble in water. In human medicine, hydroquinone is used as a topical
application in skin whitening to reduce the color of skin. It is found in common foods such as
wheat, berries, coffee, and tea, which are detoxified into inert compounds in the liver.4
Hydroquinone inhibits tyrosinase, likely by interfering with copper binding, thereby
reducing the conversion of dihydroxyphenylalanine (DOPA) to melanin. Other possible
mechanisms include selective cytotoxicity of melanocytes with melanosome degradation and
inhibition of DNA and RNA synthesis,2. 3
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Hydroquinone topical is used to lighten areas of darkened skin such as freckles, age
spots, sholasma, and melasma. Hydroquinone could decreases the formation of melanin in the
skin. Melanin is the pigment in skin that gives it a brown color. Hydroquinone is also used to
lighten the dark-colored patches of skin caused by pregnancy, birth control pills, hormone
medicine, or injury to the skin16. This product also contains sunscreens to help prevent spots from
reoccurring due to sunlight or ultraviolet light exposure. This medicine works by blocking the
process in the skin that leads to discoloration13.
In pictures below are examples of skin lightening products that contain hydroquinone and
they are available to purchase through internet. However, those products are already prohibited
in Asians market.

On August 29, 2006, the U.S. Food and Drug Administration (FDA) proposed a ban on over-thecounter sales of cosmetic products containing hydroquinone, a skin-bleaching (lightening)
ingredient.11 The reason cited for the proposed ban is that studies in rodents show some evidence
that hydroquinone may act as a carcinogen or cancer-causing chemical, although its cancercausing properties have yet to be proved in humans. Hydroquinone also has been linked with the
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medical condition known as ochronosis in which the skin becomes dark and thick 10. Domeshaped yellowish spots and grayish-brown spots also are observed in ochronosis among users of
hydroquinone. Ochroquinone-containing cosmetics for a short time7. Some studies also report
abnormal function of the adrenal glands and high levels of mercury in people who have used
hydroquinone-containing cosmetics. For these reasons, hydroquinone has already been banned12.
There are few possible side effects of topical hydroquinone including allergic reaction
such as shortnees of breath, closing of the throat, swelling of the lips or even a rash. More
commonly, some burning, stinging, itching, redness, or irritation, of the treated area may be
experienced. Besides, this medication may cause dry skin, burning, irritation, redness, cracking
or peeling of the skin. Serious side effects that could occur are a gradual blue-black darkening of
the skin (ochronosis), allergic contact dermatitis, nail discoloration and reddening of skin. These
side effects are more likely damaging the skins. Thus, hydroquinone is no longer being used in
cosmetic products4.
The Skin Disorders Related to Hydroquinone
Dermal applications of hydroquinone at concentration level below 3% in different bases
caused negligible effects from different human races. There are case reports suggesting that skin
lightening creams containing 2% hydroquinone have produced leucoderma, as well as exogenous
ochronosis.11 Hydroquinone (1% aqueous solution or 5% cream) has caused irritation such as
erythema or staining.11 Allergic contact dermatitis due to hydroquinone has been diagnosed. 5
Saveral cases of brown discoloration of the finger-nails due to hydroquinone-containing skinlightening creams have been reviewed.8
Leucoderma
Four cases of leucoderma were reported following the use of bleaching creams containing
2% hydroquinone.4 Leucoderma is commonly known as skin disease of white patches.
Malfunction of skin is the main cause, otherwise of which the skin normally produces adequate
skin pigment to give a uniform skin color throughout the body. The monomethyl ether of
hydroquinone was reported to cause an extensive confetti-like hydroquinone or the white
patches.13 Higher concentrations of hydroquinone might cause serious sensitization14.

Picture 1. White patches or leucoderma

on the face

Exogenous Ochronosis
An uncommon, yet important, adverse effect of hydroquinone is exogenous ochronosis.
Exogenous ochronosis, in which bluish black pigmentation of cartilage is noted tatrogenically by
exogenous agents, has been seen after exposure to noxious substance including hydroquinone. 6
This disorder is characterized by progressive sooty darkening of the skin area exposed to
hydroquinone. Degeneration of collagen and elastic fibers occurs in the exposed area. This
degeneration is followed by the appearance of characteristic ochronotic deposits consisting of
crescent-shaped, ochre-colored fibers in the dermis. Exogenous ochronotic has generally been
observed in patients who have used high concentrations of hydroquinone for many years.
However, cases occurring after the use of 2% hydroquinone have also been reported. 3
Hydroquinone-induced ochronosis is often difficult to treat, but it may respond to topical steroids
and chmical peeling15.

Picture 2. ochronosis reveling a perioral bluish black macular eruption after hydroquinone use.
Picture 3. upon microscopic examination, colored, oval-shaped structure are detected in the midto-upper dermal tissues (hematoxylin and eosin, original magnification X40)
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Erythema
In earlier, researchers found that a 5% cream of hydroquinone caused a high incidence of
primary irritant reactions such as erythema and tingling at site of application. 3 Erythema is an
abnormal skin redness from increased blood flow, caused by dilation and irritation of surface
capillaries. The disorder is a result from chemical reaction between the skin and hydroquinone
cream. Erythema cauld be notified as reddening spots on skin in the area that has been exposed
to hydroquinone17.

Picture 4. Reddening spots on skin synonym

as erythema

Allergic contact dermatitis

Hydroquinone is a toxic reagent that could sensitize allergy to human skin. Most common
case was reported is allergic contact dermatitis. Allergic contact dermatitis is caused by the
bodys reaction to something that directly contacts the skin.14 Many different substances can
cause allergic contact dermatitis, which in this case hydroquinone is the allergen. Usually the
skin becomes itchy and has burning sensitization on the allergic area. However, in cases of
dermatitis due to hydroquinone, removal from exposure will quickly clear up the symptoms.
Contact dermatitis occurs in a small number of patients and responds promptly to topical
steroids.

Picture 4. Allergic contact dermatitis

below the eye

Brown discoloration of nails

This could be a sign of a melanoma under the nail. Nail discoloration does not gradually
disappear as would a bruise or the size of the nail streak increases over time. The color change is
considered to be due to hydroquinone oxidation products resulting from exposure to sunlight. 8
Staining of the nails due to hydroquinone-containing creams is not a well recognized condition.
Two cases were reported by older women in whom brown discoloration developed after the use
of cosmetic skin-lightening creams for actinic lentigines of the hand

Picture 5. brown nail discoloration

Acknowledgement
The author would like to thank the assistant of English language in Trisakti University Jakarta
for their assistance in conducting the study.

CONCLUSION
After surveying the large body of literature on hydroquinone compound, it could be
concluded that long-term use of topical hydroquinone does pose an increased risk of skin
disorders and this benzene derivative no longer be used as a skin-lightening agent. A literature
search focusing on the biochemistry and toxicology of hydroquinone and related molecules, with
an aye toward the potential long-term side effects of hydroquinone use in cosmetics were taken.
As the result, intermediate use of hydroquinone was found to cause several skin disorders such as
leucoderma, exogenous ochronosis, erythema, allergic contact dermatitis and nail discoloration.
REFERENCES
1. J.Eur. acad. Dermatol. Venereal. 2006;20:781-7; Skin Therapy Lett. 2004;9:1-3.
2. Dermatol. Clin. 1998;6:18592; J.Invest. Dermatol. 1984;82:308-10
3. Int.J.Dermatol. 2005;44:112-5
4. J.Am. Acad. Dermatol. 2000;42:869-71
5. Skin Therapy Lett. 2004;9:1-3;Arch. Dermatol. 1995:131:1453-7
6. Huerta Brogeras M, Sanchez-Viera M: Exogenous ochronosis. J Drugs Dermatol 2006
Jan: 5(1)
7. http://ptcl.chem.ok.ac.uk/
8. http://www.cantonrep.com/topFive.php?
vote=2&Headline=FDA+says+products+that+lighten+skin+pose+dangers&ID=304996&
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9. http://www.emedicine.com/derm/topic528.528.htm.
10. http://www.drugs.com/pdr/hydroquinone.html.
11. http://www.inchem.org/documents/hsg/hsg/hsg101.htm#SectionNumber:2.5.
12. http://www.medicinenet.com/FDA proposes hydroquinone ban.
13. http://www.bmrb.wisc.edu/metabolomics/gen_metab_summary_5Hydroquinone.
14. http://www.global-b2b-network.com/b2b/98/100/560/page3/344029/hydroquinone.html.
15. http://www.inchem.org/documents/ehc 157.htm.
16. http://health.yahoo.com/healthwise/support-abouthw-xml/support-abouthw-editorial-xml.
17. http://en.wikipedia.org/wiki/Image:Hydroquinone-3d.png

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