Heard from a colleague that anything Fitz V or higher should never have HQ, even the OTC 2% that many of us give out for home care. She contends that it can cause more hyperpigmentation to appear later - up to 10 years later - from reactive melanocytes. Is it true? What has been your experience?

There have been cases of 2% hydroquinone use resulting in hyperpigmentation occurring within 6 months of use. The FDA has been considering banning hydroquinone in OTC medications but as yet has not done so. Personally I don't like hydroquinone. There are other alternatives out there for treating pigmentation.

I stopped retailing products with HQ approximately 8 or 9 years ago because the possibility of rebound pigment then. I know some of the alternatives don't work as fast as HQ but the risk of pigment returning worse than ever was a real concern. I experienced this after inheriting a slew of clients with rebound pigment. Most had worked with another local esthetician (working with physician strength products). More aggressive treatments spells trouble down the road.

In Fitzpatrick V the problem would be Hypo Pigmentation. HQ works on the Melanocytes and they claim they damage them with long term use. In my opinion I agree with Jacine there are many other alternatives especially with Fitz V. With Hyperpigmentation that is already there and has been resistant to other forms of therepy (IPL, Kojic Acid, Vit C therapy, Vit A, etc) I have found that HQ used on a short term basis is the only thing that makes a difference.

I agree...there are other ingredients, both natural and biochemically engendered that offer benefits to hyper pigmented skin, and which are also better for long term suppression of melanocyte activity.

I have had fantastic results with Lumixyl both on face and body on Fitzpartick V

What I recall is that HQ and Kojic burn the dendrites off of melanocytes. Somebody also warned against both HQ and Kojic for all skin types, but of course rebound pigment will be more of a problem with the more active melanocytes of higher Fitz types. I don't use HQ in my practice for this reason.

I've been tempted to try other actives such as SymWhite, but I can't help but wonder if we'll learn later on that it causes a similar effect, or worse. I'd like some reassurance through studies...