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 work up for melasma may involve the use of hydroquinone as it is indicated for the treatment of this condition.
- Key points:
- Melasma is a hyperpigmented skin condition
- Hydroquinone is used for the gradual bleaching of hyperpigmented skin conditions, including melasma 1
From the Research
A thorough melasma workup should begin with a detailed history and physical examination, including a Wood's lamp examination to determine the depth of pigmentation, as this information is crucial in guiding treatment decisions 2. The workup should start by obtaining information about the patient's sun exposure, hormonal factors (pregnancy, oral contraceptives, hormone therapy), family history, and previous treatments.
- Physical examination should include a thorough assessment of the skin to determine the extent and depth of pigmentation.
- Laboratory testing is generally not necessary unless there are concerns for systemic conditions that may cause hyperpigmentation, such as thyroid disease or adrenal disorders. First-line treatment includes:
- Strict sun protection with broad-spectrum SPF 30+ sunscreen applied every 2 hours when outdoors, wide-brimmed hats, and sun avoidance.
- Topical therapy typically begins with hydroquinone 4% applied once or twice daily for 12-16 weeks, often combined with tretinoin 0.025-0.1% and a mild corticosteroid (triple combination therapy), as this has been shown to be effective in reducing melasma severity 3. For maintenance, non-hydroquinone lightening agents like:
- Azelaic acid 15-20%
- Kojic acid
- Vitamin C
- Tranexamic acid can be used. For resistant cases, consider:
- Oral tranexamic acid 250mg twice daily for 8-12 weeks
- Chemical peels (glycolic acid 20-70%)
- Laser therapy, as these options have been found to be effective in reducing melasma severity in patients who do not respond to first-line treatments 4. Melasma is challenging to treat because it results from increased melanin production triggered by UV exposure, hormonal influences, and genetic predisposition, with melanocytes remaining hyperactive even after treatment, making recurrence common and necessitating ongoing maintenance therapy 5.