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 exogenous ochronosis caused by hydroquinone is to discontinue the treatment and consult a physician 1.
- The key steps are to:
- Stop using hydroquinone
- Seek medical advice from a physician No other treatment options are mentioned in the drug label for exogenous ochronosis.
From the Research
The most effective treatment for exogenous ochronosis is the use of a Q-switched alexandrite laser, as it has been shown to significantly lighten the pigmented skin areas without scarring or textural changes, as demonstrated in a study published in 2004 2. This condition, characterized by blue-black pigmentation typically caused by prolonged use of hydroquinone, has limited treatment options. The first step in managing exogenous ochronosis is to discontinue the use of hydroquinone-containing products. For active treatment, laser therapy is the most promising approach, with Q-switched lasers (alexandrite, ruby, or Nd:YAG) and fractional CO2 lasers being the most effective options. Chemical peels using glycolic or trichloroacetic acid may be beneficial for mild cases, while topical retinoids like tretinoin can promote cell turnover and improve appearance. Oral medications, including tetracyclines, have also shown some benefit in treating exogenous ochronosis, as reported in various studies 3, 4. It is essential to counsel patients about realistic expectations, as complete resolution of the condition is challenging to achieve, and protection from sun exposure is crucial during and after treatment to prevent further hyperpigmentation. Some studies have also highlighted the usefulness of dermoscopy in diagnosing exogenous ochronosis, as it can help identify characteristic amorphous densely pigmented structures obliterating some follicular openings 5, 6. However, the primary focus should be on discontinuing the causative agent and using laser therapy as the main treatment approach, given its effectiveness as demonstrated in the highest quality and most recent study available 2.
Key considerations in treating exogenous ochronosis include:
- Discontinuing hydroquinone use
- Using Q-switched lasers for active treatment
- Considering chemical peels and topical retinoids for mild cases
- Protecting the skin from sun exposure during and after treatment
- Counseling patients about realistic expectations and the potential need for combination therapies over extended periods.