From the Guidelines
The treatment for exogenous ochronosis should primarily focus on immediately discontinuing the use of hydroquinone or other triggering substances, as they may cause side effects such as irritation, contact dermatitis, and potentially carcinogenesis, as noted in the guideline for the diagnosis and management of vitiligo by D.J. Gawkrodger et al. 1. To address skin discoloration, several treatment options can be considered, including:
- Topical retinoids like tretinoin 0.05-0.1% applied nightly to aid in cell turnover
- Chemical peels using glycolic acid (30-70%) or trichloroacetic acid (15-25%) performed by dermatologists every 3-4 weeks for multiple sessions
- Laser therapy options such as Q-switched lasers, fractional CO2 lasers, or alexandrite lasers, typically requiring 4-6 sessions spaced 4-6 weeks apart
- Dermabrasion for severe cases It is essential to note that sun protection is crucial during treatment, requiring broad-spectrum SPF 30+ sunscreen applied every 2 hours when outdoors. These treatments aim to either remove damaged skin layers or break down deposited pigment, though complete resolution is challenging and may take months to years. Given the potential risks associated with hydroquinone, as highlighted in the study by D.J. Gawkrodger et al. 1, it is vital to prioritize prevention through avoiding triggering agents as the most effective approach.
From the FDA Drug Label
Hydroquinone may produce exogenous ochronosis, a gradual blue-black darkening of the skin If this condition occurs, discontinue treatment and consult your physician. The treatment for ochronosis exogen caused by hydroquinone is to:
- Discontinue treatment
- Consult your physician 2
From the Research
Treatment Options for Ochronosis Exogen
- The treatment of exogenous ochronosis is difficult, and improvement occurs only slowly after avoiding the offending agent 3.
- Various topical agents have been studied, as well as dermabrasion and the use of lasers, but controlled studies in larger numbers of patients are required to determine the true efficacy of newer treatments 3.
- A Q-switched alexandrite (755 nm) laser has been reported to be effective in treating hydroquinone-induced exogenous ochronosis, resulting in significant lightening of the pigmented skin areas without scarring or textural changes 4.
- Microneedling has also been identified as a potential treatment option for exogenous ochronosis, in combination with Q-switched Alexandrite laser 5.
Challenges in Treatment
- The physiopathology of exogenous ochronosis is not well understood, and therapeutic measures are not satisfactory 6.
- Exogenous ochronosis can be misdiagnosed as a melasma treatment failure, emphasizing the need for careful diagnosis and treatment planning 6.
- The indiscriminate use of hydroquinone-containing compounds can increase the risk of exogenous ochronosis, particularly in skin of color 6, 5.