Dear Paula,

I have several sun spots on my face, and it's getting worse. I tried your skin lightener but it didn't help. I then saw a dermatologist who referred me to an esthetician, who started me on the Obagi products. Things got better with this routine, except the moment I stopped using the products the spots came right back and the routine consisted of about 10 products. It was a horrible experience and took 3 months. My skin was always so dry, even painful, and peeling.

So now I have my spots again, but I can't do the Obagi routine again. In your book you recommend prescription Tri-Luma for brown patches. Do you know if this is a safe product? I ask because I have heard that prolonged use of hydroquinone products is linked to leukemia. Help!
Maria, via email

Dear Maria,

There is no way anyone needs 10 products from any skin care line regardless of the problem! Without knowing exactly what products you were using from Obagi I suspect his Nu-Derm Sunfader with SPF 15 and 4% hydroquinone, Healthy Skin Protection SPF 35 (zinc oxide-based) along with the prescription tretinoin he sells was responsible for the results you had. It is a great combination but not unique to Obagi.

Here's what you need to know:

• An immense amount of research has shown that hydroquinone and tretinoin are the gold standard for reducing brown skin discolorations but irritation and dryness are not unusual.
• The research about hydroquinone and cancer is complicated. Some research shows it actually protects from DNA damage (Mutagenesis, July 2009, pages 367-372) and others have shown it to have no direct impact (Critical Reviews in Toxicology, May 1999, pages 283-330). Overall, there is no link showing hydroquinone to be a problem for skin. Interestingly, many of the plant extracts claiming to lighten skin actually break down into hydroquinone, which is why they can be effective, just not in the amounts most cosmetic companies use.
• Prescription only Tri-Luma contains 4% hydroquinone (to lighten) with tretinoin (to generate normal skin cells) and cortisone (to reduce the irritation from the other two ingredients). It is most likely similar, at least in part, to what you were using with your complicated Obagi routine, but it is worth considering.
• 2% hydroquinone can be sold from cosmetics companies (like mine) and 4% concentrations from physicians. 2% is for minor discolorations and 4% for deeper discolorations.
• Other skin lightening ingredients such as vitamin C, niacinamide, or licorice extract are options, just not as effective as hydroquinone. Olay's Regenerist Daily Regenerating Serum is great for niacinamide and Paula’s Choice Resist Super Antioxidant Concentrate is rich in vitamin C.
• What you absolutely need to consider are numerous cosmetic medical corrective procedures such as lasers and light therapies that can make skin discolorations a thing of the past and then skin care products are great for maintenance.
• Find a cosmetic dermatologist that specializes in laser treatments to guide you through the options, discuss pros and cons of each, and help you make an informed decision that doesn't include 10 skin care products. Visit www.cosmeticdermatology.net to find one in your area.