Hydroquinone cream (prescription)

Does hydroquinone cream work, and on which dark spots?

Hydroquinone cream acts on pigment made by overactive melanocytes in the upper layers of the skin, so whether it helps depends on which dark spot you have. That is why a doctor diagnoses the pigment before prescribing it, and why the same cream can lighten one patch and do little for the patch beside it.

Where it tends to have a role

• Melasma with pigment sitting mainly in the epidermis, as one part of a supervised plan with strict sun protection; see melasma treatment.
• Brown post-inflammatory marks, once the acne or rash that caused them has settled.
• Some sun spots, although sharply outlined spots often respond less and other options are weighed.

Where it does not help

• Deeper, dermal pigment, such as grey-blue marks and Hori’s naevus, which sits below where the cream acts.
• Moles and seborrhoeic keratoses (raised age spots), which are growths, not overactive pigment, and are examined rather than bleached.
• Exogenous ochronosis, the blue-grey darkening caused by long-term hydroquinone itself.

How a doctor tells the difference

The pattern, colour and history give the first clues: symmetrical patches that follow sun, heat or hormonal change suggest melasma, marks that follow pimples suggest post-inflammatory pigment, and grey-blue dots on the cheekbones suggest Hori’s naevus. A dermatoscope and Wood’s lamp help show how deep the pigment sits. In Asian skin, melasma and Hori’s naevus often appear together, and irritation from a strong cream can add new brown marks, so strength and duration are chosen conservatively and reviewed. The types are set out under pigmentation types on the face.

What you can do at home, and what you cannot

Daily broad-spectrum sunscreen, tinted where possible, a hat and shade help every type of pigment. Gentler cosmetic ingredients such as niacinamide, vitamin C or azelaic acid can be used without a prescription. What you cannot do safely is buy hydroquinone as a cosmetic: in Singapore it is a prescription medicine, and creams sold online or in salons as whitening products may contain undeclared hydroquinone or mercury.

See a doctor if a patch is spreading, has not changed despite sun protection, darkens or turns blue-grey while you use any lightening cream, or if a single spot is changing in size, shape or colour.

When to see a doctor about hydroquinone cream

See a doctor before you start hydroquinone cream, and promptly if a patch darkens, turns blue-grey or becomes inflamed while you use it, because in Singapore hydroquinone is a prescription medicine and most reported harm follows long or unsupervised use. A 2024 review updated 15 years of safety studies after the United States ended over-the-counter sales of hydroquinone skin lighteners. An analysis of European product alerts from 2005 to 2018 found 266 reports on skin lightening products, mainly for hydroquinone, mercury or the strong steroid clobetasol.

See a doctor when:

• you want to start a lightening cream, so the type of pigment is diagnosed before anything is applied;
• a patch darkens, spreads or turns grey-blue while you use any lightening cream, which can be exogenous ochronosis rather than worsening melasma;
• the skin becomes red, itchy, scaly or swollen where the cream goes, a sign of irritation or contact dermatitis;
• you have used a cream for months without a planned break, or bought it online or in a salon without a label you can check;
• you are pregnant, planning a pregnancy or breastfeeding;
• a single spot is changing in size, shape or colour, which needs examining rather than bleaching.

A doctor confirms the pigment type, often with a dermatoscope and Wood’s lamp, before deciding whether hydroquinone has a role, then sets the strength, the length of the course and the review. The pigment types and the alternatives are compared on pigmentation types on the face and melasma treatment in Singapore.