Melasma, and hyperpigmentation in general, is one of the most common reasons people schedule an appointment with a dermatologist. Below, I’ll talk all about one of the most powerful topical ingredients we use to treat melasma, hydroquinone, and the safety concerns surrounding its use. 

Okay, let’s dive into the topic at hand: just how SAFE is hydroquinone?

Hydroquinone is one of the most powerful topical ingredients when it comes to brightening dark spots, treating melasma, combatting hyperpigmentation and evening out skin tone. It’s available both as a prescription, often found in combination with other prescription medications like tretinoin, and is also available in OTC (over the counter) products. While it’s an incredibly powerful ingredient, and often considered first line by most dermatologists in the treatment of melasma, there are safety concerns surrounding its use. Does it get absorbed into the bloodstream? Can it cause cancer? Can it damage your liver? Should I be afraid to use it?  Having researched this ingredient extensively, and having used it in the office for over a decade, I will give you my honest opinion here.

First, should you be afraid of systemic absorption, and possible risks associated with systemic absorption? Many people aren’t aware that they are being exposed to considerable amounts of hydroquinone in their diet every single day. Hydroquinone is found in nature as either hydroquinone or arbutin, which is converted into hydroquinone in the body.  Hydroquinone and arbutin are found in tea, coffee, pears, wheat bread and red wine. Studies show that human exposure to hydroquinone from our diet is significant https://pubmed.ncbi.nlm.nih.gov/8568910/  I personally consume coffee and tea every day, and I love enjoying a juicy, ripe pear as a healthy snack.  

Does hydroquinone cause cancer or damage the liver? Most of these studies were done in rats, and many were done on populations of rats that already had predispositions for growing certain cancers and tumors. Although I certainly am not going to ignore these concerning studies, it is very hard to make a convincing case that what we see in rats will translate into humans. As far as liver studies go, hydroquinone seems to actually have a slight protective effect when you look at risk for liver cancers in rats. So clearly, we really are not certain of the true impact that hydroquinone has on our different organs. So far, studies done in humans who are exposed to higher concentrations of hydroquinone have been reassuring. I honestly don’t know any board certified dermatologists in the US who are afraid to use this ingredient because of concerns surrounding its “toxicity” to the body, after having reviewed the literature and science extensively.

What we do know is that high concentrations of topical hydroquinone, especially used for long periods of time without a doctor’s supervision, can lead to a skin condition called exogenous ochronosis, or pseudo ochronosis.  

This is when we see a darkening of the skin, even darker than the original melasma that these creams were meant to treat!  Furthermore, it is near impossible to get these stains to disappear!  

These cases, thankfully, are quite rare in the United States, and much more commonly found in parts of the world where people are also using antimalarial medications. Antimalarials also cause pseudo ochronosis, so the combination of hydroquinone plus antimalarials are probably a major risk factor for this condition.

The main risks seem to be: 

using concentrations higher than 4%

using hydroquinone for years at a time without breaks, and

combining hydroquinone with other ingredients such as oral antimalarial medications.  

We also know that many “bleaching” and “whitening” creams that you can find online or in other countries are contaminated with mercury and high potency steroids like clobetasol https://www.sciencedirect.com/science/article/abs/pii/S0013935116302651

Ok, so how do I approach hydroquinone in my office with my patients.  Here are my take homes:

  • Hydroquinone should only be used under the very strict supervision of a dermatologist
  • Each patient needs to weigh pros and cons, risks and benefits of using hydroquinone vs using other treatment modalities.  In cases where melasma is severe and affecting someone’s quality of life, the benefits may outweigh the risks. It’s a personal decision between that patient and the treating physician.
  • If you have been prescribed a hydroquinone containing prescription from your dermatologist, you MUST follow up carefully. Most derms will rotate you off of hydroquinone every few months, to make sure you get prolonged breaks between uses.
  • If you have used hydroquinone, or are using it, under the close supervision of a dermatologist, don’t lose sleep over it! Remember, everyone who is drinking coffee or tea, or eating pears or sipping on red wine, is also being exposed to hydroquinone.
  • Do NOT try to get hydroquinone containing products online or through online pharmacies.  If a friend brings you an extra “magic cream” across the border and swears by it, PASS!  Warn your friend about mercury and clobetasol and other risks she/he might not even know about.

For more recommendations and discussions surrounding melasma and hyperpigmentation, check out my IGTV and YouTube channels.

Dr. Whitney

 

 

Why Alcohol in your Hand Sanitizers is NOT the Same as Alcohol in your Toner

As a doctor and a scientist, I know that alcohol can be a lifesaving ingredient in certain scenarios, but it can do harm in others.  Alcohol use in skincare products requires some serious thought. Here’s what you need to know when it comes to alcohol in your skincare products.

For your face: 

Not all alcohols are created equal.  Alcohols fall into 2 main categories: drying alcohols, and hydrating alcohols.  When it comes to products you use on your face, you want to avoid drying alcohols, but welcome the use of hydrating alcohols.

Drying alcohols are often listed on labels as SD alcohol, denatured alcohol, ethyl alcohol or isopropyl alcohol.  These are lightweight, volatile alcohols, meaning they evaporate quickly off the surface of the skin.  The problem is, these types of alcohols do major damage to the natural lipids and fatty acids on the surface of your skin, so they damage your skin barrier.  For people with oily skin, they can give you a sensation of feeling like you’re degreasing the skin and drying out the oil, but the long term damaging effects far outweigh that temporary sensation.  In fact, over time, your skin will actually pump out more oils to compensate for the stripping and drying effects these alcohols have.  So, long story short, these types of alcohols should be avoided by people of ALL skin types when it comes to their facial skin.

Hydrating alcohols, or fatty alcohols, are actually excellent ingredients when it comes to facial skincare!  Examples include cetyl, stearyl and cetearyl alcohol.  These alcohols are emollients, meaning they keep skin hydrated and supple—yes, the exact opposite of what you might expect when you see the word “alcohol” on the label!

For your hands:

Hand sanitizers that contain 60% ethyl alcohol and  70% isopropanol are incredibly effective germ killers, meaning they can kill many disease causing bacteria and viruses within seconds.  These are the kinds of alcohols I warned you to avoid in your facial skincare, but when faced with a virus like COVID-19, the benefits currently outweigh the risks when using them in your hand sanitizers. Just be sure to only use them when you don’t have access to running soap and water, and moisturize as often as possible to restore those lipids and encourage the regrowth of healthy bacteria (your microbiome).

Dr. Whitney

I love bonding with my 7 year old daughter, Maclane, and planning special activities together. We might take a mommy and me yoga class, go out to lunch, or get a manicure together as a treat for a special occasion like a birthday or wedding!

I have been getting a lot of questions this week about the safety of child facials or “baby facials” after a photo of Harper Beckham receiving this type of facial was shared on social media.

First, Is a “Baby Facial” Safe?

Children naturally have lots of collagen and hyaluronic acid in their skin, so their skin is naturally more smooth and plump than adult skin. However, they are more prone to absorbing ingredients rubbed onto their skin than adults due to a number of factors including their high surface area-to-volume ratio and immature drug metabolism systems. This can present safety concerns depending upon the type of products and ingredients used during the facial.

Additionally, some facials can use products that make the skin more sensitive to the sun. Given that children spend more time playing outdoors and are not as diligent with sunscreen, this is something to consider when providing consent for a facial treatment. Furthermore, sun damage during childhood can have especially serious consequences when it comes to skin cancer risk down the road.

And – some facials involve extractions. If those extractions are too aggressive, it could bruise, break a blood vessel, or leave a permanent “ice pick” scar in the skin.

Finally, children are generally not as careful around steam and boiling water so depending on the facial, there could be a risk of being burned.

My Opinion on “Baby Facials”

From my clinical experience (and life experience), children can be very susceptible to comments made about their skin and appearance. A well-meaning practitioner might begin a treatment by pointing out an “area of concern” or identifying “problem areas” in the skin. I would hesitate to expose my daughter unnecessarily to these types of comments given the impact they could potentially have upon her emotional well-being and self-esteem.

In my opinion, if Mac really wanted to experience a “baby facial” specifically geared toward children which involves pampering and positivity and some natural, clean skincare products, I don’t think it can hurt. On the flip side, if she feels like we are treating an “issue”, addressing a “problem”, or if she thinks she “needs” this to be beautiful/healthy, then I would most likely believe that the risk outweighs the benefit.

 

There is so much buzz surrounding mineral oil. My patients ask me about it all the time. There is a lot of misinformation out there – and a lot of it is scary (for example, many of my patients are wondering whether mineral oil can cause cancer). I wanted to give more background and information on this subject to help to separate fact from fiction. This is especially timely because products containing mineral oil (Aquaphor, Petroleum Jelly) are many people’s go-to products when their skin is dry, red, and chapped during winter.

What is Mineral Oil?

Mineral oil is a clear, odorless oil which is derived from petroleum. It comes in different grades, ranging from the technical grade – which is used to lubricate car engines and equipment – to a highly purified cosmetic grade which is often found in many of the skin care products you might have in your house.

Mineral oil and petroleum jelly are both byproducts of petroleum refinement and both are considered petrochemicals.  Recently, you may see more and more products marketed as “free of petrochemicals” or “petrochemical-free” and that means they don’t contain mineral oil or petroleum jelly.  Some popular products containing mineral oil that you probably have in your home include Vaseline Petroleum Jelly and Aquaphor.

Is it Dangerous?

There is so much ongoing confusion and even fear surrounding mineral oil and petroleum jelly. People are worried about “impurities” and “contaminants” found in mineral oil – and there is some concern that it could even be carcinogenic.

The cosmetic grade mineral oil is completely different from the type of mineral oil used to lubricate engines. It’s gone through purification processes to remove these contaminants and impurities. Mineral oil is an occlusive emollient, meaning that it helps to keep your skin hydrated by locking in moisture by forming a barrier on your skin’s surface. Based on my research, it’s actually considered very safe and rarely causes irritation or an allergic reaction.

Would I be afraid to use Vaseline or Aquaphor on myself or my family, say, after a burn or after washing out a cut or scrape?  Not at all. In fact, the American Academy of Dermatology advocates using Petroleum Jelly as standard protocol in wound care.

Do I use products with mineral oil on my skin or my daughter’s skin every day?  

I don’t, but it’s not because mineral oil scares me. Here are two main reasons I don’t rely on mineral oil containing products on a daily basis. First, I expect more from my skincare ingredients. Mineral oil isn’t irritating, and yes it is hydrating, but for me, that’s not enough justification to use it on a daily basis. I’d prefer to find ingredients that not only moisturize but also provide other benefits such as anti-inflammatory or antioxidant properties. The second reason I don’t use mineral oil containing products on a daily basis is because, even though mineral oil is unlikely to clog pores on its own, it can trap other pore-clogging ingredients in the skin. So if you use a product that combines mineral oil with another ingredient, the mineral oil can potentially trap that other ingredient in the skin.

What can I use instead of mineral oil?

Many of my patients are starting to consider other options to mineral oil and have noticed that clean beauty certifications often specifically exclude products containing mineral oil. For example, “Clean at Sephora” specifically means that the products included are free of sulfates, parabens, formaldehyde, phthalates and mineral oils.  Two of my favorite alternatives to mineral oil and petroleum jelly are shea butter and sunflower seed oil. Stay tuned for some of my favorite DIY home skincare recipes using these ingredients!

Dr. Whitney

When I was a little kid, my hair was a very white-blonde color. My mom loved to squeeze lemon juice into my hair to lighten it even more when we were at the beach. Little did she know that she was exposing her skin to a condition called phytophotodermatitis, which can result in severe chemical burns on your skin. All you need is the juice of a lemon or a lime, a bergamot orange – all seemingly innocuous citrus fruits – and sunlight. The juice reacts with sunlight and can seriously burn your skin, ranging from redness and blisters all the way to second degree burns. Even if your skin does not burn, you may wind up with substantial, lasting, skin discoloration which presents as darkened patches on the skin.

4 Ingredients that Can Cause Severe Sun Damage

So, if you use a hair lightener at the beach – like Sun In or  Sun Bum Hair Lightener, these typically include lemon juice or extract. Be careful not to leave any of this spray on your skin if you are using it on your hair.

If your child has a lemonade stand, be mindful of whether she is squeezing lemons and then exposing her skin to the sun. This is something very few parents think about, but the rashes and burns which can result are actually very real.

Other products which cause photosensitivity which can result in irritation, redness, dark spots, burns, and sun damage include:

These Essential Oils are Photosensitive

 

Certain Essential Oils: So many of my patients swear by their essential oils. They can be energizing, relaxing, and everything in between. But, if you’re going to spend the day in the sun, don’t expose your skin to: bergamot, bitter orange, grapefruit, lemon, lime, verbena, and several others. Be sure to check the information which accompanies your essential oils, as many are labeled photosensitive!

Reminder: Why Retinol Invites Burning

Retinol: I always recommend that my patients use their skin renewing retinol products at night. If you use retinol in the morning and head out into the bright sunshine, you will not have happy, healthy skin. This is a nighttime product because it makes your skin more sensitive to the sun.

Have you Heard of Hydroquinone?

Hydroquinone: This skin brightening ingredient — which helps limit the skin from producing an excess amount of melanin (which is what gives our skin its pigment and, in cases of excess production, causes brown patches and hyperpigmentation) — is also a common culprit in terms of photosensitivity. Check your labels before you use your skin cream and head out to the beach or pool!

Have a wonderful time in the sun, wear your sunscreen, and watch out for those sneaky citrus fruits!

Dr. Whitney

 

@DrWhitneyBowe

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