From the FDA Drug Label
HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation.
The diagnosis of melasma (chloasma) is not explicitly stated in the drug label, but it is mentioned as a condition for which the drug is indicated. The treatment for melasma (chloasma) is the use of hydroquinone 4% skin bleaching cream for the gradual bleaching of hyperpigmented skin conditions 1.
- Key points:
- Hydroquinone is used for hyperpigmented skin conditions
- Melasma and chloasma are specific conditions for which the drug is indicated
- The treatment is for gradual bleaching of the skin
From the Research
The most effective treatment for melasma is a multimodality approach, including sun protection, topical agents such as hydroquinone, tretinoin, and corticosteroids, and oral tranexamic acid, as supported by the most recent and highest quality study 2.
Diagnosis of Melasma
Melasma is a common skin condition characterized by brown or grayish-brown patches typically appearing on the face, particularly the cheeks, forehead, upper lip, and chin. It's more prevalent in women and people with darker skin tones, often triggered by sun exposure, hormonal changes (pregnancy, birth control pills, hormone therapy), and genetic predisposition.
Treatment of Melasma
Treatment typically begins with sun protection, including daily broad-spectrum sunscreen (SPF 30+) and physical sun avoidance.
- First-line topical treatments include hydroquinone 4% cream applied twice daily for up to 12 weeks, often combined with tretinoin 0.025-0.1% and a mild corticosteroid in what's called triple combination therapy, as recommended by 2 and 3.
- Other effective options include azelaic acid 15-20%, kojic acid, vitamin C serums, and tranexamic acid (oral or topical) 2, 3.
- For persistent cases, chemical peels containing glycolic acid or salicylic acid, microdermabrasion, or laser treatments may be considered, although their efficacy is limited and they often cause post-inflammatory hyperpigmentation, particularly in individuals with darker skin types 2, 3.
Maintenance Therapy
Since melasma often recurs, maintenance therapy and continued sun protection are essential. The condition results from increased melanin production by melanocytes, with UV exposure stimulating melanin synthesis and hormonal factors enhancing melanocyte activity, explaining why protection from sunlight is fundamental to management 4, 5.
Quality of Life
Melasma can significantly affect quality of life and self-esteem due to its disfiguring appearance, highlighting the importance of effective treatment and management strategies 3.
Recommendations
Based on the most recent and highest quality study 2, a multimodality approach to the treatment of melasma is recommended, including sun protection, topical agents, and oral tranexamic acid. This approach has been shown to be effective in improving symptoms and quality of life for patients with melasma.