Hydroquinone is an effective lightening agent used by dermatologists and aestheticians. A hydroquinone cream is sometimes referred to as a “bleaching cream” because of its ability to lighten skin tone but there is no bleach in any of these products. While there are lower-strength versions of these creams available over-the-counter, the higher strengths are only available with a prescription. Additionally, the highest strength that is commercially available with a prescription is a hydroquinone 4% cream. A cream with 6, 8, or 10 percent hydroquinone can only be obtained from a compounding pharmacy with a prescription.
Uses for Prescription Hydroquinone Creams
Skin bleaching is not used only for aesthetic purposes such as reducing signs of sun damage and aging. There are also skin diseases that cause discolorations in the skin. The most prevalent example of this is acne, which can lead to post-inflammatory pigmentation. These red spots and areas of uneven skin tone result from acne lesions that have healed but left a mark. The scarring and marks left by acne can greatly affect a person’s self confidence. A hydroquinone prescription cream can help reduce the pigmentation changes that result from acne breakouts.
Another example of a skin disease that is improved with the use of hydroquinone cream is melasma. Melasma causes larger discolored patches of skin, mostly on the face. These patches are often triggered by hormonal changes like those that come with pregnancy or by sun exposure. A hydroquinone 6%, 8%, or 10% cream may be prescribed to treat these large areas of discoloration.
What Strengths of Hydroquinone are Available?
Hydroquinone works by slowing production of melanin, which is the pigment that affects skin tone. While many patients will see results with a 2% or 4% cream, certain individuals with more sever pigmentation issues may do better with a higher-strength cream. The strengths of hydroquinone we compound at our pharmacy include:
Hydroquinone 6% Cream, Hydroquinone 8% Cream: These creams are stronger than most products that can be obtained commercially and may be used for moderate to severe pigmentation problems associated with melasma, post-inflammatory pigmentation, and sun damage.
Hydroquinone 10% Cream: This high-strength cream is usually reserved only for the most severe pigmentation issues.
Another benefit to obtaining a hydroquinone cream from a compound pharmacy is the ability to have multiple ingredients combined into one cream. Hydroquinone can be combined with an exfoliating ingredient like retinoic acid, or with other lightening ingredients like kojic acid. Other ingredients that help lighten skin include Vitamin C and azelaic acid. Hydrocortisone may be included in a combination lightening cream to reduce skin irritation that occurs due to the other ingredients.
A combination cream is sometimes called a “peel-and-bleach cream” because it both reduces melanin production and speeds up the renewal of skin cells through exfoliation. Similar to a chemical peel, these ingredients remove the top layer of dead skin to allow new, undamaged skin cells to grow. Some of these combinations include:
- Hydroquinone 6%, Retinoic Acid 0.05%, Hydrocortisone 0.5%
- Hydroquinone 8%, Retinoic Acid 0.1%, Hydrocortisone 0.5%
- Hydroquinone 6%, Retinoic Acid 0.05%, Hydrocortisone 0.5%, Kojic Acid 4%
There is a commercially available product called Tri-Luma that has a combination of ingredients including retinoic acid and fluocinolone acetonide, which is used to reduce swelling and inflammation. However, this product only has hydroquinone 4%. The higher-strength combinations must be obtained from a compounding pharmacy.
Sun Protection When Using Prescription Hydroquinone
Sun protection is essential when using high-strength skin lightening creams. Sunscreen should be worn daily whether it is sunny or cloudy outside and re-applied as needed. Skin should be covered as much as possible and the face should be protected by a broad-brimmed hat when going outside. During the middle of the day when the sun is at its peak it is better to stay indoors as that is when UV rays are particularly strong.