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Hyperpigmentation is one of the most widespread conditions seen in medical aesthetic practices and it affects patients of all skin types and ages. Effective treatments have traditionally shared one major drawback: the risk of rebound or post-inflammatory hyperpigmentation. Today, formulators and physicians are seeking ways to match the efficacy of existing treatments while providing long-term benefits.
“Hydroquinone—and especially combinations of hydroquinone with retinoids—remains the gold standard of hyperpigmentation management,” says John Kulesza, president and senior formulating chemist, Young Pharmaceuticals (youngpharm.com). “The real objective in hyperpigmentation management is to normalize the pigment output of the melanocyte. Hydroquinone remains the best validated drug for that purpose, and any compound claiming to effectively treat that indication must ultimately be compared with it, ‘apples to apples.’” While hydroquinone is the most effective ingredient available for short-term pigment inhibition, Kulesza adds, “retinoids probably have the best chance at correcting whatever is going wrong with the melanocyte that is causing it to make too much pigment.”
The downside to hydroquinone is that it’s generally offered as a short-term treatment protocol due to concerns of cytotoxicity and skin sensitivity. “Most patients on prescription hydroquinone products need to cycle off after a period of time, which allows for a rebound of the hyperpigmentation, and many patients have sensitivity issues,” says Carl Thornfeldt, MD, dermatologist, and president, CEO and chief scientific officer of Episciences Skin Care (epionce.com).
In addition, “as more government regulators are scrutinizing the long-term safety of hydroquinone, practitioners are using it more sparingly and looking for alternatives,” says Kulesza, “especially for long-term pigment management.”

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