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Exogenous ochronosis associated with hydroquinone: a systematic review
Stephanie Ishack1, Shari R Lipner2
1New York University School of Medicine, New York, NY, USA.
International Journal of Dermatology
|September 6, 2021
Summary
Hydroquinone use, especially above 4% concentration and for over 3 months, may lead to exogenous ochronosis. This skin condition, characterized by blue-black macules, is more common in middle-aged women of African descent with darker skin types.
Area of Science:
- Dermatology
- Adverse Drug Reactions
- Dermatopathology
Background:
- Exogenous ochronosis is a recognized side effect of hydroquinone use.
- Current treatment options for exogenous ochronosis are often unsatisfactory.
- Identifying risk factors is crucial for preventing this adverse event.
Purpose of the Study:
- To review existing data on hydroquinone-associated exogenous ochronosis.
- To determine patient-specific risk factors associated with developing exogenous ochronosis.
- To elucidate the relationship between hydroquinone concentration, duration of use, and ochronosis development.
Main Methods:
- A systematic literature search was conducted on MEDLINE/PubMed, Scopus, and Web of Science for articles on "ochronosis + hydroquinone".
- PRISMA guidelines were employed to select 56 relevant case studies involving 126 patients.
- Data from included articles were cross-tabulated, and Fisher exact test was used for analysis.
Main Results:
- Exogenous ochronosis was most prevalent in middle-aged women (53.2%), individuals of African descent (45.2%), Black races (55.5%), and Fitzpatrick skin types V-VI (52.4%).
- Hydroquinone concentrations greater than 4% (35.7%) and unknown concentrations (32.5%) were frequently reported.
- The median duration of hydroquinone use was 5 years; few cases involved use shorter than 1 year.
Conclusions:
- Hydroquinone use exceeding 4% concentration may be linked to new-onset exogenous ochronosis.
- Treatment courses longer than 3 months appear to increase the risk of developing exogenous ochronosis.
- Histopathological findings consistently revealed solar elastosis and characteristic banana-shaped fibers in affected individuals.
