Hydroquinone is a topical agent used to reduce skin pigmentation that can result from sun related damage such as age spots or sun spots. Hydroquinone bleaching creams are also used to decrease pigment that occurs with pregnancy or hormone induced discoloration. Hydroquinone is a naturally occurring product that inhibits an enzyme that makes pigment in our skin. When used appropriately it offers a safe and very effective therapy to treat hyperpigmentation and dark spots. It is available in over-the-counter strength of up to 2 percent and higher concentrations by prescription. In my dermatology practice I use hydroquinone frequently for many of my patients that complain of uneven pigmentation, dark marks from acne, and lightening genital area hyperpigmentation. Why does hydroquinone have a “bad wrap”? There are several reasons for this, some are legitimate and some are not so valid. Frist, the main problem with hydroquinone is that with continued long term use, hydroquinone has been associated with a paradoxical darkening of the skin. This condition is called ochronosis and is more common in other parts of the world where hydroquinone is used extensively without regulation. To avoid this rare but significant side effect, I educate my patients on its use. Secondly, there are studies in Europe and Asia involving rodents which were fed high doses of hydroquinone through a feeding tube for extensive periods of time. It’s no surprise that some of the rodents developed cancer. So far no cases of cancer have ever been proven in human using a topical cream containing hydroquinone. If one avoids eating massive amounts hydroquinone bleaching creams, then I suspect you will remain safe. Thirdly, hydroquinone topical products can make the skin more sensitive to sunlight (photosensitivity). I always recommend to my patients that either sun avoidance or sun protective clothing and sunblock be used while using a hydroquinone bleaching cream. Here is how to prevent the side effects of hydroquinone: First and foremost, one should not use hydroquinone skin bleaching creams for long periods of time. I try to limit treatment to 1 to 3 months. Then I switch to an alternative therapy to maintain results. Secondly, hydroquinone must be used with sunscreen. Many dermatologists believe that sun exposure (without sun protection) may be implicated in ochronosis. Last but not least, I always emphasize to patients that if there is any significant irritation they should discontinue use. Following these simple rules, one can safely use hydroquinone to treat dark marks and hyperpigmentation.