What is the recommended dose and frequency of hydroquinone (HQ) for skin lightening?

Hydroquinone for Skin Lightening: Dosage and Frequency Recommendations

Hydroquinone 4% cream should be applied to affected areas and rubbed in well twice daily, in the morning and before bedtime, for a maximum duration of 2-6 months. 1

Recommended Dosage and Application

• Concentration: 4% hydroquinone cream is the standard prescription strength
• Application frequency: Twice daily - morning and evening 1
• Method: Apply to affected areas only and rub in well
• Duration of treatment:
  • If no improvement is seen after 2 months, discontinue use 1
  • Maximum recommended duration is 6 months per treatment course 2
  • After 6 months, treatment should be paused to assess results and allow skin recovery

Treatment Approach Based on Hyperpigmentation Pattern

• For localized lesions (spot therapy):

  • Apply hydroquinone directly to individual hyperpigmented spots
  • Avoid application to surrounding normal skin

• For diffuse hyperpigmentation (field therapy):

  • Apply to entire affected areas 2
  • Take care to avoid unaffected skin to prevent unwanted lightening of normal skin 3

Enhancing Efficacy

• Combination therapy can improve results:
  • Add a retinoid for nighttime use
  • Consider a mid-potent topical steroid twice daily for the first 2 weeks, then weekends only 2
  • Use sunscreen (SPF 30+) daily to prevent further hyperpigmentation

Monitoring and Safety Considerations

• Regular assessment: Medical evaluation is recommended during treatment 4
• Side effects to monitor:
  • Skin irritation (most common) - may require temporary discontinuation
  • Contact dermatitis
  • Exogenous ochronosis (rare with proper use)

Important Precautions

• Pregnancy: Not recommended during pregnancy
• Pediatric use: Not recommended for children under 12 years except under physician supervision 1
• Sun protection: Essential during treatment as skin becomes more photosensitive
• Application area: Avoid application near eyes or on broken skin

When to Discontinue Treatment

• After 6 months of continuous use 2
• If irritation or sensitivity develops
• If no improvement is seen after 2 months 1
• If desired lightening effect has been achieved

Hydroquinone remains effective for treating various hyperpigmentation disorders including melasma, post-inflammatory hyperpigmentation, and solar lentigines, but should be used with appropriate medical supervision due to potential side effects with prolonged use 5.