Vadodara, India

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The skin colour of a woman's face turned into a bizarre blue-brown colour after she used a skin-lightening cream. 

According to a case reported in the New England Journal of Medicine, the condition called exogenous ochronosis had been affecting a 55-year-old woman in Vadodara, India, for a year before she went to see a doctor. 

She applied a skin-lightening cream containing hydroquinone, a skin-bleaching agent, to fix patches of hyperpigmentation or melasma on her cheeks. However, areas of her face where she applied the face cream have now turned blue-brown. 

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Nikita Patel and Hiral Shah of Government Medical College, Vadodara, India, wrote, "She had started applying a skin-lightening cream containing hydroquinone to her face daily to treat melasma. On physical examination, bluish-brown patches with background erythema [skin reddening] and telangiectasias [widened blood vessels] were observed on the cheeks, nasal bridge, and perioral region [around the mouth], with lesser involvement on the forehead."

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Exogenous ochronosis occurs when one applies hydroquinone or phenols to the skin. Under the microscopic view, skin affected by this condition appears yellowish-ochre. However, due to the scattering of light, it seems blue-brown to the naked eye. 

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According to the authors, ochronosis, a hyperpigmentation disorder, occurs when ochre-coloured deposits accumulate in the tissues. It is tough to get rid of the condition, as most treatments are preventative. Some studies suggest that a Q-switched alexandrite (755 nm) laser can treat the condition. 

"Exogenous ochronosis is challenging to treat and may not be reversible. Counselling regarding the importance of photoprotection and cessation of the use of the skin cream was given to the patient. A topical emollient and retinoid gel was also prescribed," the authors said.

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Even after two months, the woman saw only minuscule changes in her skin pigmentation levels. "At 2 months of follow-up, the patient had minimal abatement of the hyperpigmentation," the authors wrote.

Hydroquinone has several potential side effects. Using it increases the risk of developing exogenous ochronosis. Moreover, it affects the areas exposed to the sun more. 

The European Union has banned it since 2000. The United States Food and Drug Administration nearly banned it in 2006. 

The annual sale of skin-lightening products is around 10-15 million. Japan is one of the largest markets for such cosmetic items.

(With inputs from agencies)