Hydroquinone-induced vitiligo: A case report

Summary: Abstract Body: Introduction: Vitiligo is an acquired skin condition characterized by the loss of melanocytes, leading to depigmented patches on the skin. While the etiology is multifactorial, drug-induced vitiligo has been reported with topical imiquimod, TNF inhibitors, and PD-1 inhibitors. Hydroquinone, a skin-lightening agent, has rarely been associated with vitiligo, with only two prior cases linked to occupational exposure to hydroquinone-containing photographic solutions. Here, we present a rare case of vitiligo induced by topical 4% hydroquinone. Case Summary: A 31-year-old man with no prior history of autoimmune or dermatologic conditions applied topical 4% hydroquinone once daily under his eyes for dark circles. After two weeks of use, he developed a depigmented patch on his chest and white hair (poliosis) on the occipital scalp. Despite discontinuing hydroquinone, depigmentation spread to the chest, upper arm, and back. Examination revealed well-demarcated depigmented patches confirmed by Wood’s lamp. Laboratory tests, including thyroid function and autoimmune panels, were normal. A diagnosis of hydroquinone-induced vitiligo was made. The patient declined treatment for depigmentation but avoided further use of hydroquinone. Discussion: This case highlights hydroquinone as a rare but potential cause of drug-induced vitiligo, even with localized application. Unlike classical vitiligo, drug-induced cases can present in both sun-exposed and non-sun-exposed areas, as seen here. Mechanisms such as oxidative stress, melanocyte apoptosis, or immune-mediated cytotoxicity may underlie hydroquinone-induced vitiligo, though further research is warranted. Early discontinuation of the offending agent is critical to minimize progression. This case underscores the need for caution and patient education when prescribing hydroquinone for cosmetic use. Conclusion: Drug-induced vitiligo, though rare, should be considered when evaluating new-onset depigmentation in patients using hydroquinone. Early identification and discontinuation are essential to address this potentially distressing outcome. Puneet Bhullar¹, Olayemi Sokumbi¹ 1. Dermatology, Mayo Clinic, Jacksonville, FL, United States. Pigmentation, Melanoma, and Melanoma Immune Surveillance