How to Bleach Your Skin at Home

What Is Skin Bleaching?

Skin whitening or bleaching is a medical procedure for lightening skin tone or making skin complexion more even. Most skin bleaching agents work by controlling or inhibiting the activity of melanocytes, skin cells that produce melanin. Melanin is a pigment that gives the skin its natural brownish color.

Sometimes, the overproduction of melanin is not wanted because it either causes the skin’s color to be darker or causes age spots to appear on the skin. By applying a skin bleaching agent to the skin, the production of melanin can be reduced and the treated skin will be lighter.

Some products that are rich in antioxidant may also be called skin bleaching agents because they also help make the skin look clearer and healthier. Those products work by preventing skin damage caused by oxidation and eradicating free radicals. Although these products don’t change the color of the skin, their skin brightening and cleansing effect gives an illusion of lighter skin that many people love.

How To Bleach Your Skin At Home

Image: vasanr.com

The Reasons Why People Use Skin Bleaching Agent

There are two primary reasons why people want to bleach their skin: darker-skinned people use a skin bleaching agent to make their skin tone lighter and people with certain skin problems, such as scarring and age spots, use the agent to make the scarring disappear and to fade the spots.

The use of skin bleaching agent for lightening skin tone is popular especially in Asian countries, where light-colored skin is favored. The use of skin bleaching agent for overcoming age spots and scarring, on the other hand, is popular in Western countries, where age spots become a common problem among fair-skinned people.

Why Skin Bleaching Is Necessary

Skin bleaching is necessary because overproduction of melanin causes the entire area of the skin or specific spots on it to become darker. This abnormal production of melanin is caused by excessive exposure to the sun. When the sunray reaches the skin, the body tries to protect its deeper skin layers as well as internal organs from the harmful effect of the sun’s ultraviolet ray by forcing the melanocytes to produce more melanin.

The overproduction of melanin will cause sunspots (also called age spots or liver spots) to appear on the skin of fair-skinned people and cause the skin of darker-skinned people to become even darker. Most skin bleaching products are used either to kill the melanocytes or to prevent the overproduction of melanin.

Is Skin Bleaching Risky?

The short answer for this question is yes, skin bleaching is risky. The most commonly used skin bleaching agent, hydroquinone, is strictly regulated in most countries and its use may cause irritation. If you have acne or another skin problem on your skin, the use of hydroquinone may aggravate your skin condition. A study carried out by the Department of Dermatology, Institut d’Hygiène Sociale, Dakar has affirmed the aggravating effect of hydroquinone.

There are even reports stating that healthy skin becomes diseased, red, burned, and dry because of the use of certain skin bleaching products. The risk becomes even more terrifying in countries where skin whitening becomes a trend. Due to market demand, various skin bleaching products, many of which are unlicensed and unregulated, are available in the market. When used, they may severely damage the skin.

Even if you use products that are considered safe, there is always a possibility that the whitening effect of those products will not work evenly on the skin. Imagine if you try to use any of those products on your face. A portion of it will appear whiter whereas the other portion will be darker. This is obviously uglier than having a darker-colored face, isn’t it?

To avoid such risk, you have to make sure that skin whitening is your last resort to improve your beauty. Using skin cleansing and brightening products is much more recommended because they least likely cause problem to your skin. Some of those products even make your skin healthier. However, if you insist on resorting to skin bleaching, be sure that you consult your doctor beforehand.

In brief, the following are some risks that you may face if you use a skin bleaching product.

  1. Premature aging of the skin

Most skin whitening agents suppress the production of melanin. Because one of the functions of melanin is to keep your skin youthful, if you suppress its production, the sun can easily damage your skin and cause wrinkles to appear.

  1. Skin cancer

Melanin prevents the sun from damaging the inner layers of the skin and triggering cancer growth. By reducing this protective pigment, you will be at a greater risk to suffer from skin cancer.

  1. Skin diseases

Some skin whitening products use corticosteroid that prevents inflammation and allergic reaction. However, steroid may also cause unwanted side effects, including acne, skin thinning and poor healing of wound. It can also cause problem to many internal organs if it is absorbed by the skin.

  1. Ochronosis

Prolonged use of hydroquinone may damage the skin and darken its color—a condition that is called ochronosis.

  1. Allergy

This is a very common risk that you may face if you apply something to your skin. Different people have skin with different level of toleration towards alien substances. Allergy may occur if your skin is sensitive to the substance you use.

  1. Mercury intoxication

Whenever you want to buy a skin whitening product, you should always beware of mercury. Any products that you use must not include mercury as one of their ingredients. Remember that mercury has a lot of names, including mercurio, mercuric, mercurous, and calomel. If you see any of those terms in the label, you should not use it.

To minimize those risks, you have to make sure that you consult a specialist before attempting to use any types of skin whitening product, including natural ones.

Why Should You Consult a Doctor?

There are many reasons why a consultation with a doctor can make sure that your use of skin bleaching products will be safe and effective.

  1. If you want to use the product to whiten your entire face, your doctor will give you advice about the most suitable product for your skin and the best way to use it. Sometimes, your doctor’s prescription is the only means to get the product that you want.
  2. If you want to use the product to get rid of age spots and other skin problems, your doctor can perform diagnostic treatment to make sure that you are dealing with the right problem. Although age spots have clear characteristics that are easy to identify, your doctor can perform more accurate diagnosis. If necessary, your doctor may need to carry out skin biopsy to clarify the condition that affects your skin.
  3. Your doctor or dermatologist can perform some cosmetic therapies that are intended to lighten your skin. Your doctor may perform cryotherapy to your skin to freeze the affected skin and to kill its melanocytes, laser therapy to burn the overproduced pigment, or chemical peel or dermabrasion to exfoliate the affected skin.
  4. Even if you want to bleach your skin at home, as the title of this article implies, you still need your doctor’s advices to make sure that your home remedies work effectively.

No matter which path you want to take to bleach your skin, it is always highly recommended that you consult a doctor or a dermatologist. Doctor visit indeed costs you some money, especially because skin whitening treatment is considered a cosmetic treatment that your insurance will not cover; however, the danger of improper use of skin bleaching procedures or products is much bigger than the amount of money that you spend to pay the doctor.

Over-the-Counter Products that You Can Use at Home

After consulting a doctor, your doctor may recommend you use a certain product that you can buy at a nearby drugstore or online one. Here is a list of skin whitening products that your doctor may prescribe for you.

  1. Hydroquinone
Hydroquinone Chemical Structure

Image: chemistry.about.com

When you are reading about skin whitening products, hydroquinone will mostly appear on the top of the list. Hydroquinone has long been considered the most common skin whitening product that effectively eliminates overproduced melanin and makes the skin lighter.

Hydroquinone may be used alone or with other skincare substances, especially retinoid and corticosteroid. Retinoid (marketed as Tretinoin) is a vitamin A-related substance with ability to treat various skin problems, including psoriasis, acne, aging skin, and cancer. Corticosteroid (marketed as Fluocinolone) reduces inflammation and allergic reactions. A commonly used skincare product that combines the three substances is Tri-Luma.

When applied to the skin, hydroquinone prevents your skin from producing melanin. Because your skin produces melanin to protect the inner layers of the skin from sunburns, you should avoid direct exposure to the sun when using hydroquinone because without protection, the sun can easily burn your skin. Using sunscreen is also recommended when you use hydroquinone to lighten your skin.

Although considered very effective skin whitening agent, hydroquinone can be harmful. Therefore, make sure that the concentration of hydroquinone that your product has is 2% or less. Don’t buy any skin whitening products that contain hydroquinone but don’t show information about its concentration.

  1. Arbutin
Bearberry Plant-Arctostaphylos

Image: en.wikipedia.org

Arbutin Chemical Structure

Image: pubchem.ncbi.nlm.nih.gov

Arbutin is a substance derived from bearberry plant. Often considered a safer alternative to hydroquinone, arbutin becomes a popular skin whitening agent lately among people who are afraid of the harmful effects of hydroquinone. Arbutin is actually a type of natural hydroquinone that can still cause harmful effects; however, the side effects of arbutin occur more rarely and less severely.

Instead of killing melanocytes, arbutin suppresses the activity of those pigment-producing cells by inhibiting tyrosinase, an enzyme important in melanin production. This, in turn, makes arbutin work more slowly than hydroquinone does, but safety of use makes it a preferable skin whitening agent for many people. The marketed arbutin is the one with alpha isomer because alpha-arbutin is more effective in inhibiting tyrosinase than beta-arbutin.

  1. Kojic Acid
KojicAcid Chemical Structure

Image: chemistry.about.com

Kojic acid is one of popular skin whitening agents that are available today. A byproduct of the fermentation of rice, kojic acid is fairly easy to acquire and now available as an over-the-counter product. Although it has the same capability to inhibit tyrosinase with that of hydroquinone and arbutin, it might not show the same effectiveness in all of its users. Some people may find kojic acid better than hydroquinone whereas the others may feel that hydroquinone is a better option for them.

The Journal of Cosmetic Dermatology has reported that kojic acid is far less powerful than hydroquinone in controlling the production of melanin and Dermatologic Surgery in 2001 reported that kojic acid may cause allergy. The best kojic acid product that you can find today is the one that is combined with hydroquinone. Will kojic acid be suitable for you? You should consult your doctor to find that out.

Those three skin whitening agents are the most popular over-the-counter products that are widely used by people who are dealing with problems related to skin tone and sunspots. There are indeed many other substances whose skin whitening effect is still under exploration, such as azelaic acid and glutathione.

The Journal of Drugs in Dermatology has also published the beneficial effect of topical vitamin C in the treatment of sunspots. Because you have to rely on your doctor’s prescription to try any of those products, you may want to talk with your doctor to understand more about their efficacy and side effects. If your doctor prescribes you to use any of those products, you can use them to bleach your skin at home.

How to Bleach Your Skin at Home Using Homemade Remedies

 

If you prefer to resort to all-natural skin whitening agents, there are actually many home remedies that you can use to treat your sunspots or to make your skin tone lighter. The following are some of the most commonly used homemade skin whitening remedies that have been proven to show positive result when used.

 

Potato

Potatoes for Skin Bleaching

Image: en.wikipedia.org

Potato is believed to be a potential natural skin lightening agent because it contains catecholase enzyme that promotes skin whitening. If you want to use potato to lighten your skin tone or to get rid of annoying spots on your skin, take the following steps.

  • Prepare fresh potatoes. Peel and wash them.
  • Grate the peeled potatoes and put the pulps in a bowl.
  • Rub the area of your skin that you want to lighten using the potato pulps.
  • Do this once every day until you get the expected result

You may need to be patient if you want to use this home remedy because the change might be noticeable after you treat your skin using this remedy for a couple of weeks or months, depending on your skin condition.

 

Lady’s mantle

Lady’s Mantle for Skin Bleaching

©Jerry Pavia Photography, Inc

This plant has long been regarded as one of women’s best friends due to its capability to solve many women’s problems. If you are having heavy period, you can use the extract of its leaves to reduce the excessive flow of blood. If your breasts are sagging and you want to make them firmer, you can massage your breasts using the extract. Lady’s mantle is also known to have skin whitening effect. If you want to use it for this purpose, take the following steps.

  • Prepare Lady’s mantle’s leaves and clean them using fresh water.
  • Crush the leaves until soft and soggy.
  • Squeeze the crushed leaves above a strainer so that you can extract their juice.
  • Once you get the juice, there are two possible ways to use the extract.
  1. You can dab the juice on all age spots that you want to lighten.
  2. You can mix the juice with water and use the water to wash your skin. You can also use the solution to cleanse your skin before using your cosmetics.

 

Turmeric

Turmeric for Skin Bleaching

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Turmeric is yellow spice that is widely used in Asian cuisines. Turmeric is available either as rhizomes or as powder. The coloring and lightening effect of this plant is so powerful that even if you only hold it using your palm for a while, the palm will become yellowish. Turmeric is also known to be natural dye for textiles. If you want to use turmeric to bleach your skin, take the following steps.

  • Buy dry turmeric powder and limes from local grocery.
  • Extract the lime juice and then mix it with the turmeric powder to create a turmeric paste.
  • If you don’t like the harsh feel of lime juice, you can replace it with any types of essential oil.
  • Apply the paste to any spots that you want to remove or apply it evenly to the entire area of your face if you want to lighten your face.

 

Licorice

Licorice Root of Glycyrrhiza glabra for Skin Bleaching

Image: en.wikipedia.org

If you are a darker-skinned person and you want to lighten your skin tone, licorice extract can be a great homemade remedy to try. Here are the steps that you should take if you want to use this home remedy.

  • Get the necessary ingredients: licorice extract and jojoba oil.
  • Mix the licorice extract with the oil using ratio 1:8. Put the mixture in a bottle.
  • Close the bottle’s lid and shake the mixture until you see some bubbles in the bottle.
  • Dab the mixture on your skin using a cotton pad or a piece of clean and soft cloth.
  • Do this every day until you see some change on your skin.

 

 

 

 

Hydrogen Peroxide

Hydrogen Peroxide for Skin Bleaching

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If you have been using hydrogen peroxide as antiseptic, you should know that this bleaching liquid is capable to bleach your skin and make it lighter. Hydrogen peroxide works by exfoliating the dead skin layers of your skin and making your skin appear lighter and brighter. To use this home remedy, here are easy steps that you should take.

  • Dab it on your skin.
  • Allow it to dry.
  • Rinse it with water.

 

 

Tomato Leaf Oil

Tomato Leaf Oil for Skin Bleaching

Image: enaissance.co.uk

Tomato leaf oil is known to potentially lighten dark-colored skin or skin with sunspots. Here are three easy steps to take if you want to use tomato to make your skin lighter.

  • Mix tomato leaf oil with essential oil. You can use any essential oils that you have, but the most recommended oils are sandalwood oil and sesame oil.
  • Use the mixture to massage your skin.
  • Do it every day and your skin will appear lighter, healthier and more beautiful.

 

 

 

 

Chamomile

Chamomile for Skin Bleaching

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Chamomile has long been known as a potent natural remedy for lightening hair. Lately, it becomes evident that this aromatic flower is also capable to lighten skin. Here are the steps to use chamomile to lighten your skin.

  • Prepare the flower. You can use either the flower or the tea bag.
  • Steep the flower or the tea bag in hot water.
  • Use the steam to steam your skin.
  • The tea can also be used when it has become cold. Let it be cold and then use it to wash your skin.
  • Do this regularly and your skin tone will gradually change.

 

 

 

Oatmeal

Oatmeal for Skin Bleaching

Image: organicfacts.net

Oatmeal is not only healthy to eat, but also great for exfoliating your skin. It makes your skin lighter by removing all dead skin cells on the surface of your skin and giving your skin a naturally beautiful look. To use oatmeal as an exfoliating agent, here are steps that you should take.

  • Prepare all necessary ingredients, including oatmeal, honey, milk, and brown sugar.
  • Mix all of the ingredients and create a paste from them.
  • Use the paste to massage your skin.
  • Rinse your skin using clean water.

Although all of those remedies are considered natural, don’t ever think that they will not irritate your skin. Use them as long as they don’t irritate you. If irritation starts to occur, you may want to cease using them or to consult a doctor.

 

Yam bean

Yam Bean for Skin Bleaching

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Another idea for the natural home remedy to bleach your skin in order to deal with the problem of sunspot or even for getting the more even skin tone is by using Yam Bean. The benefits of yam bean are to improve the skin health and also to improve the tone of the skin. Of course, you need to use yam bean regularly.

Why yam bean is great for improving the skin tone? Sure, that is because of the high level of vitamin C which is really needed for the skin cell regeneration for getting the younger look skin. Vitamin C also plays a great role to make the skin looks more radiant and brighter.

Another benefit of yam bean is to help getting rid the spots of acne since it consists of rotenone, pachyrhizon,  vitamin C and B1. Another good thing which you can obtain from using yam bean regularly is to make your skin fresher. That is because it gives the cooling effects to the skin. As the result, it will also make the skin relaxed.

Since we have known all of the benefits of yam bean as the natural home remedy for improve the skin tone, of course it is important to know how to use yam bean to get the better skin.

  • Prepare the yam bean properly you can use the medium size one. Sure, you need to clean it well first using water and peel its skin properly.
  • Cut the yam bean into two parts and then you can grate it properly.
  • Wring the grated yam bean properly until we get the juice. Then, let stand the yam bean juice for about one hour until there is the white precipitated parts which look like a flour.
  • Separate the precipitated flour from the water since we are going to use the flour.
  • Then, we can use the yam bean flour as the skin mask by applying it all over the skin properly.
  • Let stand for couples of minutes until the mask gets dry.
  • Then, rinse the skin properly using the clean water and dry it us using clean and soft towel.

This kind of home remedy can be obtained and applied once in a week, at least. By the regular use of the mask, you will get an even skin tone which looks more vibrant and radiant.

 

Lemon

Lemon for Skin Bleaching

Image: en.wikipedia.org

Besides yam bean, lemon is also that great as the ingredient to bleach your skin naturally.  Many of you perhaps have known that lemon is great for skin to make it brighter and fresher. However, it is worth a try way which might be a good yet safe solution to deal with the skin health and tone.

So, you would not need to deal with the chemical skin bleaching which might be unsuitable for your sensitive skin. Lemon is high of vitamin C so that it will be really effective to make the skin fresh and brighter. That will also be that simple as long as you use it regularly.

There are some great effects which you can obtain then, as like it will help to fade the black spot including the acne spots and also the sun spots. Then, of course it will make your skin much lighter and fresher because of its high vitamin C.

How to use lemon to make your skin lighter, fresher, and smother? Here are some simple steps you can follow:

  • Prepare the fresh lemon water which you need and also pure honey. Mix them well. For the lemon juice of one lemon, you can use about one table spoon of honey.
  • Clean your skin well.
  • Apply the mixture of honey and lemon to your skin thoroughly. Let stand for about twenty minutes.
  • Rinse the skin properly using the clean water.

That is the simple steps you can obtain for dealing with the natural bleaching need of your skin.  For the lemon juice, it is important to get the juice from the fresh lemon. Then, for the honey, use the pure one. Raw honey will be much better to be chosen.

Yoghurt

Yoghurt for Skin Bleaching

Image: en.wikipedia.org

Besides using the fruits and vegetables, we also can use yoghurt as the idea of the natural home remedies of skin bleaching. Yoghurt has a lot of benefits for the skin health and beauty. It is not only for making it smoother but also it can make your face brighter and flawless.

That is why yoghurt is often chosen as the solution for so many skin problems, including the uneven skin tone, acne scars and spots, and many others. Sure, for getting all those benefits, you only need to apply yoghurt as the skin bleaching mask regularly at least twice a week.

Here are the steps for using yoghurt as a natural home remedy for the skin bleaching:

  • Cleanse your skin thoroughly.
  • Apply plain yoghurt all over the skin and never forget to massage it properly. It will give relaxation and helps yoghurt to be well absorbed.
  • Then, leave it for about fifteen minutes.
  • Rinse it well using warm water.

Yogurt can also be great for scrubbing. That will also help you to brighten up your skin. That is also really simple and similar from the above steps, but you only need to add coffee powder to the yoghurt before applied.

You also can replace coffee powder to cocoa powder. However, you have to choose the pure cocoa powder or coffee powder. For the yoghurt, you need to choose the plain yet quality ones.

 

Baking soda

Baking Soda for Skin Bleaching

Image: healthyfoodhouse.com

Another way for getting more even skin tone, you can also try baking soda as the natural home remedy bleaching. Baking soda is not only great for making cake or bread but also for getting the more beautiful skin.

However, you need to be really careful on using baking soda as the natural skin bleaching. You could not apply and leave it for a long time on your skin. In addition, baking soda is not whitening your skin but it is more about bleaching your skin.

There are some steps you can do for dealing with the natural skin bleaching using baking soda:

  • Prepare olive oil and baking soda.
  • Cleanse your skin properly and apply the mixture of baking soda and olive oil.
  • Massage the skin properly and let stand for couples of minutes, for about five minutes only.
  • Rinse it well using the clean water.

Baking soda is really that great not only for bleaching your skin. It also helps to deal with the acne spots, black spots, and even for your acne problem. If you have acne problem, it is better for not to scrub it using baking soda.

You can only apply it and rinse it well properly without scrubbing. It will help to improve the skin condition and make the acne get dried soon. You can apply the baking soda bleaching and treatment for your skin at least about once until two times per week. Do not use it more frequent since it will result the dry skin.

 

Pineapple juice

Pineapple Juice for Skin Bleaching

Image: healthline.com

Another super fruit to bleach your skin naturally is pineapple. This tropical fruit is not only that yummy to be enjoyed but also it has a lot of benefits, not only for your health but also for your skin.

As all of us have known, pineapple has the high level of vitamin C and antioxidants. It is also high of bromelain. That is the enzyme which is found in pineapple which can simply remove the dead skin cells especially of the burns. That is why pineapples are great for removing the fine lines, black spots, and even remove acnes. That also helps improving the skin tone to be much better.

For getting all the benefits, the steps are really easy, as shown below:

  • Mix well the pineapple juice and also coconut milk with the ratio of 1:1.
  • Then, using the cotton ball, you can apply the mixture of pineapple juice thoroughly to your skin.
  • Rinse the skin well using warm water after twenty minutes.

The combination of pineapple juice and also coconut milk is totally great for the skin. Pineapple can bleach the skin, while the coconut milk will increase your skin moisture.

So, it means you will get the flawless, more even skin tone, and also the smooth skin. The key is doing the treatment regularly, at least once in a week. That will give such a perfect result then.

 

Orange Peels

Orange Peels for Skin Bleaching

Image: naturalsociety.com

Besides lemon, orange is also great for the natural skin bleaching. You can use the orange peels as the ideas for bleaching your skin naturally. The peels of orange have great benefits as well to the health of the skin. That is including for making your skin brighter and also really smooth. It consists of the great high vitamin C and also antioxidants which are also great for the skin health and beauty.

The steps for using the orange peels for your skin bleaching are below:

  • Prepare the orange peels and make it really dry by draining it under the sun or even by processing it using oven.
  • Grind the dry orange peels into the fine powder.
  • Cleanse your skin well.
  • Mix the orange peel powder with fresh raw milk.
  • Apply to your skin properly and let stand for about a half of an hour.
  • Rinse the skin using warm water.

 

Cornstarch

Cornstarch for Skin Bleaching

Image: amazon.com

Another idea for bleaching your skin at home using the natural home remedy is by using cornstarch. You can use the natural and pure one for getting the best result and riskless process. Sure, you will get a lot of great benefits.

Cornstarch would not only be great for skin bleaching but also it will be great to make your skin smooth. It will also help you dealing with the sunspot and also the skin burn problem. That is because it has the great effect on helping your skin to get so relaxed.

The steps for bleaching your skin naturally using cornstarch:

  • Mix two table spoon of cornstarch with about two tea spoon of almond oil.
  • Add couples of lemon juice drops and mix it properly.
  • Apply the mixture to your skin properly and leave it for about 15 minutes.
  • Rinse your skin using the warm water.

Sure, cornstarch will make your skin not only goes brighter but also smoother. You can do the treatment once a week. With the regular natural treatment, you will get the perfect result of the better skin condition.

 

Papaya

Papaya for Skin Bleaching

Image: kitchensneed.com

Another good idea for bleaching your skin naturally is by using papaya. The fruit consists of high papain enzyme which is great for removing the dead skin cells and gives the chance for the new skin cells regeneration. That is great for helping you dealing with the dark sports on your skin or even the uneven skin tone.

The steps for bleaching your skin using papaya are shown below:

  • Mashed some papaya slices into the puree texture.
  • Add a little bit almond oil into the papaya puree and mix it well.
  • Cleans your skin and apply the papaya puree thoroughly.
  • Let stand for about fifteen minutes and rinse it well using the warm water.

You can do and try the natural treatment for bleaching your skin regularly for getting the best result. Three times a week will be a good idea for you to do the treatment.

Bleaching the skin naturally will give you a lot of advantages. Of course, it will be riskless especially if it is compared to the chemical ones. However, you could not expect for the instant result. It will take time but of course you will get the safe yet natural result which can be satisfying as long as you do the treatment regularly.

Then, even though all of the natural home remedies for skin bleaching above are completely natural, you need to do some allergic test. That is because each skin has its own condition. So, you need to do the test first before getting the treatment regularly.

Conclusion

Skin bleaching is always a favored treatment because it removes age spots and lightens dark skin tone. There are various treatments, drugs and home remedies that you can use to bleach your skin. No matter which bleaching agent that you use, be sure that you are always under the supervision of a skin specialist. Skin bleaching is risky. By playing safe, you can make sure that you can avoid all of its risks.

Additional reading resources:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834696/
http://palaeo.gly.bris.ac.uk/melanosomes/melanin.html
http://www.drugs.com/cdi/hydroquinone-cream.html
http://emedicine.medscape.com/article/1104184-overview
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657227/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801997/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583891/

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