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Hydroquinone is a topical depigmenting agent for hyperpigmentation; prolonged exposure may rarely cause asymptomatic, reversible orange-brown discoloration of the nail plate. A 52-year-old woman on nightly 8% hydroquinone for melasma developed sharply demarcated distal orange-brown chromonychia after one month. Workup including blood counts, liver and renal tests, vitamin levels, and nail histopathology was unremarkable. After alternative etiologies such as medication effects and organ failure were considered, the presentation was attributed to topical hydroquinone.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/association-of-hydroquinone-with-nail-discoloration-case-report/460442/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/association-of-hydroquinone-with-nail-discoloration-case-report/460442.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why does orange nail discoloration require thorough evaluation?","Question",{"text":112,"@type":113},"Orange-brown nail discoloration can indicate systemic conditions such as autoimmune disease, organ failure (cardiac, hepatic, or renal), or vitamin/mineral deficiencies. It also has benign causes and medication-related adverse effects, so a workup is needed to rule out serious etiologies.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did the case show after the patient started hydroquinone for melasma?",{"text":117,"@type":113},"A 52-year-old woman developed sharply demarcated, non-blanching orange-brown distal fingernail discoloration about one month after nightly use of topical therapy containing 8% hydroquinone for melasma. Toenails and some fingers were spared.",{"name":119,"@type":110,"acceptedAnswer":120},"How was hydroquinone-induced nail discoloration determined in this report?",{"text":121,"@type":113},"The clinicians performed laboratory testing (complete blood counts, liver and renal function, and vitamin levels) and evaluated nail clipping histopathology. After ruling out alternative causes, the diagnosis of orange nail discoloration secondary to topical hydroquinone use was made.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},460442,1791079198,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Case Reports in Dermatology  \n\n| Case Rep Dermatol 2026;18:18–24 |  |\n| --- | --- |\n| DOI: 10. 1159/000549766\u003Cbr>Received: October 2, 2025\u003Cbr>Accepted: November 13, 2025\u003Cbr>Published online: November 27, 2025 | © 2025 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/cde](www.karger.com/cde) |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nSingle Case  \nAssociation of Hydroquinone with Nail Discoloration: A Case Report  \nDevyn H. Zaminskia Joseph R. Stollb Shari R. Lipner b  \naNYU Grossman School of Medicine, New York, NY, USA; b Israel Englander Department of Dermatology, Weill Cornell Medicine, New York, NY, USA  \nKeywords  \nOrange nail discoloration · Hydroquinone · Skin depigmenting treatment · Case report  \nAbstract  \nIntroduction: Hydroquinone is topical depigmenting agent that is frequently used to treat hyperpigmentation disorders. Prolonged contact exposure can lead to asymptomatic, reversible orange discoloration of the nail plate. Case Presentation: A 52-year-old woman of Hispanic ethnicity presented to our dermatology clinic for follow-up of melasma, 2 months after initiating hydroquinone therapy. She also was taking isoniazid andrifampin therapies for reactivated tuberculosis. On physical examination, she had sharply demarcated, non-blanching, orange-brown areas of discoloration affecting the distal fingernails. Nail clipping histopathology and serologic testing for vitamin deficiencies, complete cell blood count, and liver and renal functioning were unremarkable. After ruling out alternative etiologies and considering causes such as antituberculosis treatment, a diagnosis of orange nail discoloration secondary to topical hydroquinone use was rendered. Conclusion: The differential diagnosis for orange chromonychia is broad and requires a thorough workup to rule out autoimmune diseases, organ failure (cardiac, hepatic, renal), and vitamin or mineral deficiencies. It is important to consider comorbidities, medications, and contact and exogenous exposures into consideration. Awareness and patient education of this rare side effect may prevent unnecessary distress and, in some cases, avoid unnecessary testing.  \n© 2025 The Author(s) .  \nPublished by S. KargerAG, Basel  \nCorrespondence to:  \nShari R. Lipner, shl9032  [med.cornell.edu](med.cornell.edu)  \nCase Reports in Dermatology  \nCase Rep Dermatol 2026;18:18–24 19  \n\n| DOI: 10. 1159/000549766 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cde](www.karger.com/cde) |\n| --- | --- |\n\nZaminski et al.: Hydroquinone and Nail Discoloration  \n\n| Established Facts\u003Cbr>• Hydroquinone is the active ingredient in skin depigmenting creams used to treat hyperpigmentation disorders.\u003Cbr>• Several cases of orange-brown nail discoloration following use of hydroquinone topicals have been documented; however, only one study included skin of color patients. |\n| --- |\n| Novel Insights\u003Cbr>• We report a case of a patient with skin of color who developed orange nail plate discoloration 1 month after initiating hydroquinone therapy for melasma.\u003Cbr>• This adverse effect is asymptomatic and is likely underreported in patients with skin of color, though it still requires thorough evaluation to rule out other etiologies of orange-brown chromonychia. |\n\nIntroduction  \nOrange nail discoloration is a clinical finding that warrants thorough evaluation to rule out underlying systemic conditions, including cardiac, hepatic, or renal failure, autoimmune disease, and vitamin or mineral deficiencies. It may result from benign etiologies including the use of nail polish, contact with dyes, spices, or foods, or as an adverse effect of certain medications. Hydroquinone is a widely used topical depigmenting agent that can be ","cbCaisAvdb5Qdrjt","https://ap.wps.com/l/cbCaisAvdb5Qdrjt","pdf",2216732,"English","# Introduction\n## Case Presentation\n## Conclusion\n# Established Facts\n## Novel Insights","[{\"question\":\"Why does orange nail discoloration require thorough evaluation?\",\"answer\":\"Orange-brown nail discoloration can indicate systemic conditions such as autoimmune disease, organ failure (cardiac, hepatic, or renal), or vitamin/mineral deficiencies. It also has benign causes and medication-related adverse effects, so a workup is needed to rule out serious etiologies.\"},{\"question\":\"What did the case show after the patient started hydroquinone for melasma?\",\"answer\":\"A 52-year-old woman developed sharply demarcated, non-blanching orange-brown distal fingernail discoloration about one month after nightly use of topical therapy containing 8% hydroquinone for melasma. Toenails and some fingers were spared.\"},{\"question\":\"How was hydroquinone-induced nail discoloration determined in this report?\",\"answer\":\"The clinicians performed laboratory testing (complete blood counts, liver and renal function, and vitamin levels) and evaluated nail clipping histopathology. After ruling out alternative causes, the diagnosis of orange nail discoloration secondary to topical hydroquinone use was made.\"}]","Association of Hydroquinone with Nail Discoloration - Case Report | PDF",1790758484,18]