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To the Editor.—
A common over-thecounter preparation used for "skin lightening" is 1% hydroquinone (Esoterica). A paradoxical side effect we have seen in several patients with the chronic usage of this product is a diffuse orange-brown pigmentation of the nails (Figure). This color is irreversible, but it can be prevented in those patients who are using it on the face by a thorough washing of the fingers after usage and a careful avoidance of the nails when applying. A spokesman for the manufacturer says the discoloration is due to oxidation of hydroquinone and that the same color can be seen on the surface of the cream if it is exposed to air for a long time.
The importance of recognizing this cause of discolored nails lies in the large differential diagnosis of orange-brown nails, which includes bleaching of pigment from nail varnish, staining from mercury-containing creams, subungual hematoma,
Garcia RL, White JW, Willis WF. Hydroquinone Nail Pigmentation. Arch Dermatol. 1978;114(9):1402-1403. doi:10.1001/archderm.1978.01640210081039