Dermatologic Therapy, Vol. 20, 2007, 308–313 Printed in the United States·All rights reserved Copyright © Blackwell Publishing, Inc., 2007
Skin lightening preparations andthe hydroquinone controversy
Department of Dermatology, Wake Forest University School of Medicine,Winston-Salem, North Carolina and Dermatology Consulting Services, High Point, North Ccarolina
Skin lightening preparations are widely used in dermatology by persons of all Fitzpatrick skin types. Fitzpatrick skin types I–III require local pigment lightening for the treatment of hormonally induced melasma and postinﬂammatory hyperpigmentation caused by acne and trauma. Fitzpatrick skin types IV and darker have an even greater need for skin lightening for social reasons, as well aspigmentary changes that occur around the eyes, in the intertriginous areas, following dermatitis, or with acne and trauma. The gold standard dermatologic agent for skin lightening was hydroquinone,until regulatory agencies in Japan, Europe, and most recently in the United States questioned thesafety of this substance. This has encouraged research into alternative agents to inhibit skin pigmen-tation such as retinoids, mequinol, azelaic acid, arbutin, kojic acid, aleosin, licorice extract, ascorbicacid, soy proteins, and N-acetyl glucosamine. The efﬁcacy and safety of each of these ingredients isexamined as possible topical alternatives to hydroquinone.
hydroquinone safety, pigment lightening, topical skin-lightening cosmeceuticals
Even skin color is considered a universal sign of youth and beauty. Pigmentation problems typically do not arise without injury and/or advancing age, creating a tremendous market for productsdesigned to lighten skin. These products exist inthe prescription, over-the-counter (OTC) drug,cosmeceutical, and cosmetic realm. Yet, the perfectskin-lightening ingredient has yet to be developed.There is a ﬁne line between substances that aretoxic to the melanocyte and agents that interruptone of the key steps in melanogenesis. Many chem-icals induce decreased pigment production in aPetri dish, but few can translate this in vitro obser-vation into clinical efﬁcacy. The stratum corneumand superﬁcial epidermis present formidablebarriers protecting the fragile melanocytes fromtoxic substances. After all, injury to the melanocytesresults in the pigmentary abnormalities requiring dermatologic intervention.Pigmentary abnormalities can take severalforms, depending on skin type. The most commonabnormal pigmentation results from mild tomoderately photodamaged skin characterized by dyspigmentation, in addition to ﬁne wrinkles andtactile roughness (1,2). Individuals with Fitzpatrick skin types I–III demonstrate this photoinducedchange. The irregular pigmentation is labeledfreckling in young persons and lentigenes in moremature individuals. Although this type of clonalproliferation of melanin is seen in fair-complectedindividuals, it may also be seen in Fitzpatrick skintypes IV and darker. In addition to photodamage,there are some types of familial dyspigmentationthat can be observed in all skin types. These conditionsinclude melasma, hormonal effects of estrogen onpigment production, and periorbital darkening, which is particularly common in persons whosegene pool can be traced to India. Acquired forms of pigment darkening are termed postinﬂammatory hyperpigmentation and may be the result of acne,trauma, thermal burns, etc. This is the most common
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