When Great Acne Products Go Wrong
Sometimes even wonderful acne products can have unintended and really detrimental consequences. Even the best formulas can contain ingredients that don’t work—or cause unexpected skin damage—in a few users. It may be that 99.9% of users will get great results but 0.1% will be sorry. And that’s the problem we have with some but by no means all of the Murad products for acne.
It’s enough of a problem we feel have to say something for the public good, but we do want to put it in context.
Dr. Howard Murad is arguably one of the most knowledgeable dermatologists in the world today. A professor of medicine at the Geffen School of Medicine at the University of California at Los Angeles, Dr. Howard is famous for designing a collection of skin care products for the full range of cosmetic concerns.
Labeled a “Beauty Genius” by Elle Magazine, Dr. Murad has appeared on countless television programs and is the author of four books, including The Murad Method (St. Martin’s Press, 2003), Wrinkle-Free Forever: The 5-Minute 5-Week Dermatologist’s Program (Griffin Trade Paperbacks, 2004), The Cellulite Solution (St. Martin’s Press, 2005), and The Water Secret: the Cellular Breakthrough to Look and Feel 10 Years Younger (Wiley, 2010), which was a #1 bestseller at both Barnes and Noble and Amazon.com.
And the truth is, we think most of his products are great. We just have one problem, and it’s more than a peccadillo for many people who have Asian skin. Many Murad products lighten skin with hydroquinone.
What Is Hydroquinone and What Does It Do?
Hydroquinone is a very mild organic acid. Traditionally, and still in China today, hydroquinone has been made by adding the metal manganese to aniline dye, the chemical that revolutionize the world of fashion 150 years ago by making it possible to mass-produce cloth in shades of purple and mauve. In the rest of the world, hydroquinone is made from benzene in way that produces hydroquinone and acetone, the latter product better known as nail polish remover.
When hydroquinone is applied to the skin, it is absorbed into the melanocytes, skin cells that make skin pigment. Inside these cells, it binds with an enzyme called tyrosinase. Through a series of chemical reactions the combination of hydroquinone and tyrosinase turns into a trigger for the production of tissue-destructive antigens by the immune system, localized in the skin. These antigens destroy the melanocyte, and as more and more melanocytes are eliminated, dark spots turn lighter.
Hydroquinone begins to fade discoloration of the type left behind when acne heals after about a month. It takes another 4 to 12 months for the spot to fade away completely. Like most products that alter the appearance of the skin, there are various possible side effects.
Skin-to-skin contact with another person can cause their skin to fade. The effects of hydroquinone are canceled out by tanning or excessive sun exposure, and sun exposure can cause pigmentation to come back after the spot has been removed. The hydroquinone cream can run and fade pigment in skin that was already the right tone. It can cause drying and flaking of the skin and minor skin irritation. And it can cause spotting on the conjunctiva, the inner membranes of the eyelids.
But for some people who have Asian skin types, or Hispanic skin types, hydroquinone has a much more serious side effect.
Hydroquinone and Ochronosis
In ochronosis, the process of immune destruction is not limited just to the pigment-producing melanocytes. The melanocytes can fuse with nearby tissues to dye them black and blue. The collagen in in cartilage can be broken down, too, but in ochronosis, it is replaced by hydroxyapetite, the same mineral compound that is found in bone. Discoloration of the skin is likely to be permanent and is very literally more than skin deep.
Ochronosis can be triggered by either hydroquinone or resorcinol, an antibacterial compound found in many acne products. This form of the disease is known as exogeneous ochronosis.
The condition can also occur as a result of a hereditary fault in the creation of tyrosinase. The hereditary form of the disease is known as endogeneous ochronosis.
Some people who have Asian skin types, especially Japanese people, may have mild cases of endogenous ochronosis that become cosmetically devastating when they are combined with exogeneous ochronosis triggered by the use of hydroquinone. Even products that contain just 2% hydroquinone can cause permanent changes in the skin. The majority of people who use these products will not develop ochronosis, but about 1 in 25,000 does. For that 1 in 25,000, it’s a devastating condition.
Your Doctor May Not Know About Ochronosis
Hydroquinone isn’t just for dermatologists any more. The medical literature encourages family practitioners to prescribe hydroquinone, too. One article written a team of dermatologists at Mt. Sinai Hospital in New York City (none of them Dr. Murad) entitled “Hydroquinone Therapy for Post-inflammatory Hyperpigmentation Secondary to Acne: Not Just Prescribable by Dermatologists” offer the opinion that:
“Because steroids should not be applied to the face for prolonged periods, care should be taken when a hydroquinone cream containing a steroid is chosen. If post-inflammatory hyperpigmentation consists of a few lesions, spot therapy is useful. If post-inflammatory hyperpigmentation consists of many lesions, field therapy is favored. Safety concerns with hydroquinone consist only of occasional irritation, which can be suppressed with topical steroid or a short drug holiday. Physicians should feel comfortable to use hydroquinone without consulting a dermatologist.”
The article goes on to say that there are just 25 cases of exogeneous ochronosis in the USA every year, and when the condition has occurred in people who had Black skin, well, they were ignorant and they just used too much. The implication seems to be that only white people have problems with discoloration after acne, anyway. Of course, the exact opposite is true. It’s primarily people who have Asian or African skin types who experience spotting of the skin after acne. And it’s primarily Japanese people who are especially sensitive to the medication, although there also relatively large numbers of people who have the problem in the Czech Republic and in Santo Domingo in the Dominican Republic.
So Are We Giving Dr. Murad a Bum Rap?
But this brings us back to Dr. Murad. Murad skin care products are intended for use under no supervision at all. If you happen to use one of the many Murad products that contains hydroquinone, there would be no one to warn you about the potential problems of ochronosis until it became too late.
We can recommend many Murad products. We just caution you not to use the products that contain hydroquinone—especially if you are Japanese heritage or you have dark skin. Safer products that contain arbutin and kojic acid are likely to be better for you.