Hydroquinone for Melasma

Melasma is difficult to treat condition with no cure but there are several treatment options available that can reduce its appearance. The mainstay treatment for melasma is prescription hydroquinone cream. Topical treatments are generally the most effective way to treat melasma. They have fewer side effects than systemic medications and are applied directly to the areas of concern. The topical hydroquinone for melasma that is available commercially is in lower dosages than can be obtained from a compounding pharmacy. There are also compounded creams with unique combinations of ingredients that work synergistically to treat melasma.

What is Melasma?

Melasma is a condition that most commonly presents in women and causes patches of mostly brown or tan discolored skin – primarily on the face. It is frequently triggered by sun exposure and the hormonal changes of pregnancy. During pregnancy, melasma can be especially difficult to treat because the hormonal changes are a continuous trigger. Genetics determine the risk for developing melasma. While there is little that can be done to prevent susceptibility to melasma, triggers can be managed and treatments can be prescribed that greatly improve quality of life. Treatment for melasma requires long-term maintenance with topical medications, chemical peels, and proper sun protection.

How Does Hydroquinone Treat Melasma?

Hydroquinone inhibits the enzyme tyrosinase. This enzyme is essential to convert DOPA to melanin in the skin.  With melasma, melanin is over-produced in certain areas of the skin. Hydroquinone inhibits melanin production to reduce the appearance of the brown and tan patches of discoloration. It takes about 5-7 weeks of using a hydroquinone cream for results to become apparent. That is why it is important to stay with a treatment regimen and not be discouraged if results are not immediately visible. Some patients will go on short courses of treatment for a few months and other will use the cream for up to a year.

Combination Creams with Hydroquinone for Melasma

Hydroquinone for melasma can be made in a cream on its own or combined with other ingredients like retinoic acid and corticosteroids. The first-line therapy for melasma is usually a combination cream with these ingredients:

Retinoic Acid: Retinoic acid (also called tretinoin) also decreases tyrosinase activity and increases turnover of skin cells. On its own, retinoic acid takes longer than hydroquinone for results to become noticeable. However when the two are combined they have synergistic effects. Retinoic acid is prescribed in strengths of 0.025, 0.05, and 0.1 percent.

Hydrocortisone: A steroid like hydrocortisone can enhance the effects of other ingredients. It also decreases the irritation that may be caused by hydroquinone and retinoic acid. Hydrocortisone is included in prescription melasma creams in strengths of 0.5 or 1 percent.

Kojic Acid: Kojic acid is another lightening agent that has been shown to increase the effectiveness of hydroquinone when they are combined in one cream. It has been shown that kojic acid increases the effects of hydroquinone significantly. In one study, 60% of patients had more than half of their melasma cleared with a combination hydroquinone cream that contained kojic acid compared to 47.5% without it. Kojic acid is prescribed in strengths of 2, 4, or 6 percent.

Strengths of Hydroquinone for Melasma

Hydroquinone is usually prescribed in 2%-6% strengths for treating melasma. There are no commercially available products with a strength higher than 4 percent. Higher strength prescriptions can be obtained from a compounding pharmacy. We frequently make hydroquinone 6, 8, and 10% creams for patients with more severe pigmentation concerns. When using higher strengths, it is especially important to monitor results with a dermatologist and be vigilant about sun protection. Redness and irritation may occur initially when starting use of hydroquinone cream for melasma but his often clears after a few weeks. Long-term use of higher-strength hydroquinone creams is generally not recommended. However it can be useful to get quick results before starting a maintenance regimen with a lower-strength cream.

Other Therapies for Melasma

The second-line therapy for melasma is often chemical peels. A series of peels with Jessner’s and TCA solutions can be used in conjunction with daily use of a combination hydroquinone cream. Azelaic acid cream has also been shown to be effective. It is one of the main ingredients in a melasma mask we compound, which is part of our melasma kit. The melasma kit comes with a melasma mask, a melasma maintenance cream, cleansing facial pads, and a peptide cream. The maintenance cream and the mask both contain hydroquinone.

• Melasma Mask: Azelaic Acid 15%, Hydroquinone 8%, Kojic Acid 4%, Tretinoin 0.1%
• Melasma Maintenance Cream: Hydroquinone 6%, Kojic Acid 4%, Tretinoin 0.05%, Hydrocortisone 0.5%
• Clear Face Pads: Salicylic Acid, Sulfacetamide Sodium, Clindamycin
• Peptide Cream: Hyaluronic acid and DMAE for face and neck

For more information about our cream with hydroquinone for melasma, call our pharmacy today. Our care team is happy to assist you in getting the essential melasma treatments you need.

Research

• Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. – Dermatologic Surgery
• Topical Treatment of Melasma – Indian Journal of Dermatology
• Treatment of Melasma – Journal of the American Academy of Dermatology