Skin that is a consistent color is definitely more harmonious, but is lighter always better? Anyone using a skin whitener over a long period of time runs the risk of pigmentation increasing to the joints of the fingers, toes, buttocks and ears. The skin of the face can become thinned and the area around the eyes can have increased pigmentation causing a “bleach panda effect.”
One of the most common skin lighteners is Hydroquinone. It comes in 2 percent (available in cosmetics) to 4 percent (or more) concentrations (available r by prescription), alone or in combination with tretinoin 0.05 percent to 0.1 percent. Hydroquinone also known as Eldoquin, Epiquin Micro, Lustra, Melanex requires a prescription.
How much do they cost? Starting costs for hydroquinone alone is prescription strength 4 percent (28.4 g): $44.00, nonprescription strength 2 percent (28.35 g): $28.90
Hydroquinone does not bleach the skin but lightens it, and can only disrupt the synthesis and production of melanin hyperpigmentation. It has been banned in some countries (e.g. France) because of fears of a cancer risk.
How well does it work? Hydroquinone – 2 percent to 4 percent. The highest concentration is most effective, but may be associated with more severe irritant contact dermatitis, hypopigmentation of surrounding skin, and, rarely, a bluish-black discoloration .
Because of hydroquinone’s action on the skin, it can be irritant, particularly in higher concentrations of 4 percent or greater and predictably when combined with tretinoin. Some medications have been created that combine 4 percent hydroquinone with tretinoin and a form of cortisone. The cortisone is included as an anti-inflammatory. The negative side effect of repeated application of cortisone is countered by the positive effect of the tretinoin so that it does not cause thinning of skin and damage to collagen.
In addition to being an anti-wrinkle cream, tretinoin also lightens the skin. But research has shown that the use of Tretinoin (also known as all-trans retinoic acid) can only be somewhat effective in treating skin discolorations.
Azelaic acid: requires a prescription. is naturally occurring component of grains, such as wheat, rye, and barley. Azelaic acid is used to treat acne, but it is also effective for skin discolorations.
How well does it work? In randomized trials, azelaic acid 20 percent cream or 15 percent gel was found to be more effective than hydroquinone 2 percent and equally effective as hydroquinone 4 percent. Common adverse effects of azelaic acid include erythema, burning, scaling, and pruritus.
Cream (Azelex External) 20 percent (30 g): $274.56, Gel (Finacea External), 15 percent (50 g): $232.18.
Some alternative lighteners are natural sources of hydroquinone. They are safer but more expensive. They include Mitracarpus scaber extract, Uva ursi (bearberry) extract, Morus bombycis (mulberry), Morus alba (white mulberry), and Broussonetia papyrifera (paper mulberry). All of these contain arbutin (technically known anhydroquinone-beta-D-glucoside). Pure forms of arbutin are considered more potent for affecting skin lightening (alpha-arbutin, beta-arbutin, and deoxy-arbutin). Beta-Arbutin is also known by its more common name of Bearberry extract. Arbutin is derived from the leaves of bearberry, cranberry, mulberry or blueberry shrubs, and also is present in most types of pears.
Kojic acid also naturally occurring and does not require a prescription. It is a by-product in the fermentation process of malting rice for use in the manufacturing of sake, the Japanese rice wine. Many cosmetic companies use kojic dipalmitate as an alternative to kojic acid because it is more stable in formulations. In addition to local irritation, kojic acid may cause allergic contact dermatitis.
Monobenzone and mequinol are depigmenting agents. They do not require a prescription unless they are combined with treninoin or hydroquinone.
Depigmenting agents can permanently destroy the melanocytes that produce skin color. It’s a chemical form of vitiligo, the condition that Micheal Jackson claimed to have had.
These agents work best where there are specific zones of abnormally high pigmentation such as moles and birthmarks. Conversely, in cases of vitiligo, unaffected skin may be lightened to match the affected skin and therefore achieve a more uniform appearance.
Other options are Cinnamomum subavenium is a Chinese herb, Niacinamide, licorice extract (specifically glabridin), pomegranate extract, ellagic acid, vitamin E, and ferulic acid.
Beware of skin-whitening products that use any form of mercury which can be harmful.
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