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Hydroquinone cream is the standard depigmentation or skin lightening agent. Clinically it is used to treat areas of dyschromia, such as in melasma, chloasma, solar lentigines, freckles, and post-inflammatory hyperpigmentation. This activity outlines the indications, mechanism of action, methods of administration, important adverse effects, contraindications, and monitoring of hydroquinone, so providers can direct patient therapy to optimal outcomes in conditions where it is indicated. Objectives: Outline the indications for using hydroquinone therapy. Describe the mechanism of action of hydroquinone. Summarize the potential adverse events associated with hydroquinone. Review interprofessional team strategies for improving care coordination and communication to advance improved outcomes using hydroquinone when indicated. Access free multiple choice questions on this topic.

No significant toxicity has been found with the topical use of the hydroquinone cream. Some studies report malignancies in animals treated for an extended period with large oral doses.[2] Hydroquinone in the Environment In the environment, hydroquinone is a chemical and can be toxic in human and industrial activities by promoting the generation of reactive oxygen species, oxidative stress, and hence the potential for DNA damage. It is a major benzene metabolite and is known to be hepatotoxic and carcinogenic in these settings. Some studies suggest it can promote tumor cell growth and suppress the immune response. It is used in photography and is present in dyes, paints, varnishes oils, and motor fuels. In its oxidized form, it is more toxic and less degradable. It demonstrates high toxicity to aquatic organisms and rodents and may induce leukemia, renal tubular cell tumors, and liver cancer. It has also been found to influence immune cell responses and cause an increase in an allergic reaction by increasing interleukin-4 production and immunoglobulin E levels.[13]

The interprofessional healthcare team, such as physicians, nurses, and pharmacists, plays an essential role in monitoring patients on hydroquinone. It is important to monitor patients to ensure that they only use the medication as prescribed for no more than 5 to 6 months to limit side effects. Nursing staff can play a significant role in monitoring the patient and evaluating compliance, as it is important to follow instructions for the medication application and its frequency and keep a watchful eye for any adverse affects, which should be clearly explained to the patient. Patients should be instructed to cease using the medication if any irritation, hypersensitivity, or allergic reaction occurs. Pharmacists can review the use and adverse events when dispensing the drug, and monitor when the patient comes in for refills, alerting the prescribing clinician regarding any concerns. The rare yet most potentially harmful side effect of ochronosis needs to be explained to patients using hydroquinone, and they should be instructed to discontinue this medication immediately if this occurs. A collaborative interprofessional team approach to hydroquinone therapy will guide outcomes most effectively. [Level 5]