Along with a growth in awareness about beauty standards, the current population is simultaneously experiencing an increase in skin problems contributing to 1.79% of the global disease
burden, impacting their social lives and self-esteem.
Skin issues and growing awareness of the importance of skin health have resulted in an increasing need for effective and safe products. The rising disposable income and the growing middle-class population further aid this factor. Among the vast range of skin care products, Hydroquinone, marketed in skin-lightening products for almost 50 years, remains the most frequently used whitening constituent.
What makes it better than other depigmenting agents
Clinical trials have shown conditions of facial hyperpigmentation or melasma to respond better to 4% Hydroquinone than other potent depigmenting agents like Kojic acid and Vitamin C derivatives. While a higher efficacy and faster onset of actions are some of the chief reasons for the improved effectiveness, the way either drug works on the skin cells impacts the final results considerably. Both agents are tyrosinase inhibitors. But Hydroquinone exhibits additional effects like degradation of melanosomes, destruction of melanocytes and inhibition of DNA and RNA synthesis, resulting in visibly improved and long-lasting results.
While it is true that animal studies have shown Hydroquinone to induce benign neoplasms in the kidneys of male rats dosed orally either by gavage of 25 and 50 mg/kg body weight or diet (0.8%), the study also showed that the renal adenomas and hyperplasias occurred in animals with severe or end-stage nephropathy; making researchers conclude that touting Hydroquinone as a carcinogenic agent is an exacerbation and the compound is safe for human skin. During the 40 years of its advent in the medical market, there has not been a single documented case of either a cutaneous or internal malignancy associated with this drug in humans.
When we talk about Hydroquinone, it can mean Hydroquinone as a monotherapy or combination drug.
Hydroquinone monotherapy refers to the single use of Hydroquinone for skin conditions, which was previously considered the gold standard for melasma conditions, but the long-term efficacy of which has proved unpredictable in several situations. Triple combination Hydroquinone was developed as a safer alternative to the original drug that incorporated the dual benefits of skin-lightening agents Hydroquinone and Tretinoin with the safety of Fluocinolone.
Triple Combination Cream is currently the only US FDA-approved drug for the topical treatment of melasma and the only FDA-approved product containing Hydroquinone. Its use as both continuous therapy and maintenance treatment further increases its popularity in people with long-term pigmentation conditions requiring extensive drug use.
Several clinical trials have previously emphasized the short-term usage of monotherapy Hydroquinone and discouraged extending its application beyond six months. On the other hand, Combination Hydroquinone has been known to have safe use for longer.
Multicentric safety studies performed over twelve months on 569 subjects with moderate to severe melasma have observed an 80% resolving pigmentation in a safe manner. Other comprehensive reviews of long-term and short-term treatment of melasma using a combination of Hydroquinone in a once-daily application have produced similar results and highlighted both the drug’s safety and efficacy.
While Hydroquinone exerts its action as a Tyrosinase Inhibitor and inhibits melanin production, Tretinoin protects it from getting oxidized and facilitates the removal of the existing pigmentation by accelerating the keratinocytes turnover. It even enables its penetration through the stratum corneum of the dermis to accelerate its effects better. The addition of the corticosteroid effects of Fluocinolone inhibits melanocyte metabolism while reducing the inflammatory side effects produced by the two drugs.
Recent studies have further shown that other than their role in pigment dispersion, these medications can play a role in reducing facial scarring while taking into consideration its collagen growth factors.
Cost-effectiveness factor
What makes skincare products inaccessible to several people is their high cost. Quality cosmetic agents often cost more because of the addition of active ingredients or unique elements made using advanced technology and high-quality ingredients. Keeping in mind the cost factor, researchers have developed Triple Combination Therapy using Hydroquinone, Tretinoin and fluocinolone acetonide by the brand name of Tri-Luma that produces visible brightening effects along with being cost-effective.
Studies conducted to evaluate the cost-effectiveness of Tri-Luma in comparison to Hydroquinone have found a 30% better rate of complete clearing than Hydroquinone with a lower cost in the U.S. and an incremental cost in other countries. In every country, the price per primary success was lower for Triple Combination Hydroquinone than for Hydroquinone. Other studies have produced similar results on cost-effectiveness and validated its supremacy as a skincare cream.
What about Hydroquinone use in pregnancy conditions
The prevalence of melasma in pregnant women is around 70%, which decreases gradually after pregnancy but does not entirely disappear. Unfortunately, neither monotherapy Hydroquinone nor combination Hydroquinone is an effective solution for the matter. Combination hydroquinone contains Tretinoin, which can be harmful to the foetus. Animal studies regarding the safety of Hydroquinone have not been conducted, and it is not known whether it can be used in pregnant or breast-feeding women without risking the fetus.
Conclusion
Hydroquinone is an effective treatment option for hyperpigmentation spots caused by melasma, ageing, freckles and sun spots. While it is debatable whether it can help with active acne, dermatologists recommend it as an effective remedy for acne scars. Earlier, monotherapy was considered the best treatment option. Combination Hydroquinone has emerged as a safer and long-term option with fewer adverse reactions. Despite its benefits, it should be used as per the treatment plan of your health care provider and combined with sunscreen for skin safety against photo-oxidation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817488/
https://www.tandfonline.com/doi/abs/10.3109/09546630903341945?journalCode=ijdt20
