Pigmentary problems are common and include post-inflammatory hyperpigmentation, hipopigmentation, dyschromia and melasma. Yet the threat of a ban from the FDA in 2006 put a cloud over the agent widely considered in the U.S. to be the gold standard for treatment of these skin problems — hydroquinone.

The proposed ban of its over-the-counter sales was based on controversial murine models suggesting that hydroquinone could act as a carcinogen, along with reports, also controversial, linking the product with exogenous ochronosis. The FDA’s action was met with strong opposition from the largest user of hydroquinone, the aesthetic dermatologic community, which was adamant in its assertion of the product’s safety, and, after the four-month period of public comment, no regulatory action was taken.

But the issue was never officially put to bed, and with hydroquinone bans currently on in the European Union, Japan and Australia, doctors and patients alike may be justified in wondering if hydroquinone remains on borrowed time in the U.S.

pigmented lesions treated by lasers

These bans on hydroquinone have prompted research into botanicals and other agents, including kojic acid, arbutin, mequinol and azelaic acid, as alternatives for treating skin pigmentation. So far, however, no blockbuster treatments have emerged.

Laser treatments offer a very good alternative to the drug solution. Many pigmented lesions can be safely and successfully removed even on dark-skin individuals. It is also important to realize that some of the pigmentation complications after a laser surgery or laser treatment may have been avoided if the right laser modality was used in the first place.

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