Prescription vs. Over the Counter
When it comes to treating discoloration with a cream or lotion, the most effective ingredients inhibit ‘tyrosinase’, the enzyme that triggers pigment production. The problem lies in getting the tyrosinase-inhibitor to its intended target. Most products won’t work, or won’t work well enough, because a)their power to suppress tyrosinase isn’t strong enough, and/or b) they just don’t penetrate far enough into the skin (for more on this, see Spotty Progress).
For a long time, hydroquinone was the gold standard in tyrosinase-inhibitors, and there were few other contenders. Then, a study found that high concentrations could induce cell death (albeit very rarely), and now hydroquinone goes about shrouded in a little cloud of controversy, often pointed to in horror by competitors who have a benign bearberry, licorice or kojic acid alternative to offer.
Truth is, most dermatologists still reach for the hydroquinone. Partly because they have that option (hydroquinone requires a prescription in strengths greater than 2% - and it takes a greater percentage to make a perceivable difference) and also, most dermatologists have seen no or only minor problems (such as a rash) from having prescribing it. Lastly, it’s what doctors are familiar with - none of the aforementioned alternatives are prescription ingredients, hence no point for pharmaceutical reps to be pushing them.
But don't think this is a case of big bad pharma squeezing out the readily available ‘ingredient that could’. They just can’t. You’ll see a little difference with the alternatives, but not a lot. Even prescription-strength hydroquinone often has little effect on its own and needs to be delivered with a heavy hand – another prescription ingredient, retinoic acid which penetrates deeper, dragging the hydroquinone with it.
There are a few drawbacks with prescription options. The more aggressive the product (again, needed in the case of discoloration) the more noticeable and uncomfortable the ‘breaking-in’ phase will be – count on a month or more of dryness, redness and peeling. The second drawback is the price (the traditional prescription-based Obagi line, which is excellent, costs about $400 - $500 to start).
Bottom line is - even with strong prescription products, it’s difficult to eliminate discoloration. While the new department and drug store brands may promise ‘luminosity’, or ‘brightening’, a word they’ll shy away from is ‘lightening’. This is an example of corporate VET – using vague, unquantifiable terms keeps them from being sued for false advertising.
Re: Before and after photos offered by manufacturers of ‘brightening’ products. I’ve said it before, but it bears repeating: sunscreen is the best beauty cream. A lot of the difference between ‘before’ and ‘after’ could be attributable to test subjects wearing sunscreen daily. Brown spots soak up the sun and look darker within hours, sometimes minutes, of exposure. Limit sun exposure and spots will naturally fade.
