Reports have been streaming in from physicians and their staff throughout New York, Massachusetts, New Hampshire, Montana, and Texas. What they are reporting is that they have been notified by Obagi Medical Products (now a division of Valeant Pharmaceuticals), that starting November 1, 2013, they will no longer be shipping any of their hydroquinone products to physicians in those states.
This effectively means an immediate moratorium on the Obagi Nuderm system, Obagi CRx system, and the Elastiderm Décolletage system, and any parts of those systems that actually contain hydroquinone. The notice does not appear to give an explanation as to why action has been taken in those states specifically and not others. Texas is the least surprising due to the fact that the Texas district attorney has tangled with Obagi in the past, blocking their ability to ship into the state at times. More recently, Texas Governor Rick Perry vetoed a bill that would legally clear the way for companies like Obagi to sell products to physicians for dispensing, citing public safety concerns (details of that story found here).
However, no such public issue has been foreshadowed for the other states. Some have surmised that with the success of new alternatives to hydroquinone for treating hyperpigmentation, and perhaps also due in part to recent lawsuits against doctors and/or manufacturers of hydroquinone products brought by individuals claiming to have suffered permanent side effects, larger companies may be limiting their sales and distribution through physicians as a precaution.
For those physicians that still use and recommend hydroquinone products in their practices, the primary advice is to ensure each patient is informed of the potential for side effects (even if such potential is considered unlikely), and that they are informed of the available alternatives for addressing skin tone issues such as melasma, photo-damage, age spots and PIH. Doing so and documenting it will help limit liabilities should the patient become dissatisfied with the outcome of such product use.
The other advice for hydroquinone prescribing doctors? Ensure your patients take a break from using it every couple of months, for a few months. This will help reduce the risk of resistance issues, and what some doctors describe as severe rebounding (a return of melasma in the skin after use, that become more stubborn, and therefore harder to treat than the original occurrence). Here again, having a non-hydroquinone skin brightener will help immensely by giving the patient a maintenance regimen to keep and improve upon the progress they have made in clearing up their skin discolorations.
The ongoing trend in removing hydroquinone from commercial skincare products appears to remain firmly in place in the United States, as it has been (dating back further) in many countries around the world. This latest news comes as a surprise some, as well as being a headache and disruption to their practice. However disturbing, it appears to be just one more step in the same road we have been traveling.
Stay tuned, there will be more to report as this story develops.