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Using Hydroquinone and Ochronosis

Rule No: 1

  • Recognize melasma (chloasma, pregnancy mask)
  • Rule out the differential diagnoses:
  1. lichen planus pigmentosus (darker skin patients (Indians), pigmentation is often seen behind the ears)
  2. Hori’s Nevus
  3. Drug-induced hyperpigmentation
  4. ochronosis

 

 

Rule No: 2

If the patient reports worsening of melasma with hydroquinone use, consider seriously the diagnosis of ochronosis:

  • Stage 3 ochronosis is easy to recognize
  • Stage one is more difficult to recognize
  1. It can clinically mimick melasma
  2. It is characterized by speckled appearance and feels rough on palpation
  3. Dermoscopy (Dermatoscopy) can be useful to make the diagnosis

 

 

Rule No: 3

  • Do not use Hydroquinone for more than 9 months. Consider changing creams if no response.
  • There have been 2 case reports of ochronosis occuring after less than one year of use of Hydroquinone 2% (low concentration)… therefore it is not that rare

 

 

Source of information. Thng STG. Pigmentary Disorders. NSC Update 2012. Singapore 

Original article: here