Should You or Shouldn't You?
Top docs debate the pros and cons of popular anti-aging treatments
The Pros: If you've got spots, you may have tried hydroquinone, the gold-standard skin bleach. "In prescription-strength doses of 4 to 10 percent, it's the most effective topical ingredient for fading brown patches and spots, particularly when combined with tretinoin," says Wu. Products with a 2 percent or lower concentration of hydroquinone can be purchased without a prescription. Since pigment originates deep in the skin, fading it can be slow going. But hydroquinone, which blocks the production of pigment by inhibiting an enzyme called tyrosinase, is potent and works faster than natural tyrosinase-inhibiting lighteners like kojic acid and arbutin. Prescription-strength doses are meant for short-term use and must be monitored. "I instruct my patients to use it a few times a week and see me in the office regularly," says Wu.
The Cons: Hydroquinone requires monitoring because it can be highly irritating if used incorrectly, causing redness, flaking and breakouts, warns Manhattan dermatologist Paul Jarrod Frank, author of Turning Back the Clock Without Losing Time. This irritation can actually increase pigmentation. The disorder, called ochronosis, is extremely rare, however. It occurs in less than 1 percent of users, generally those with very dark skin. Instead of hydroquinone, Dr. Frank recommends a new doctor-sold product called Elure, which breaks down existing pigment with a natural mushroom-derived enzyme. "It works 90 percent as well as hydroquinone, but doesn't irritate and can be used indefinitely."
The Bottom Line: If you're looking to lighten dark spots or hyperpigmentation—especially from acne- or injury-related scarring, then dermatologist-supervised hydroquinone treatment may be extremely effective. But be on the lookout for side effects such as ochronosis, increased sensitivity to light, irritation or allergic reactions.