Hydroquinone for Melasma

Hydroquinone for Melasma - A Snapshot

- Hydroquinone is a widely recognised and effective skin-lightening agent used for the treatment of melasma. It acts as a potent inhibitor of tyrosinase, the enzyme responsible for melanin production.

- Hydroquinone is available in various concentrations, with 2% formulations typically available over the counter and higher concentrations (up to 8%) requiring a prescription.

- The Kligman formula combines hydroquinone, a retinoid (tretinoin), and a corticosteroid (fluocinolone acetonide) to enhance efficacy and reduce irritation.

- Triluma is a commercial product based on this formulation not available in Australia, containing 4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide.
Various modifications have been made to the Kligman formula, with the most common formulation compounded at Skin Plus Compounding Pharmacy being 4% Hydroquinone, 0.01% tretinoin and 0.5% hydrocortisone.

- Typical instructions given to patients is to apply the compounded cream only to the affected darker areas once daily at night, just before bed, for a period of three months. A break of 1 to 2 months is usually suggested to limit the potential of exogenous ochronosis.

- Exogenous ochronosis is a hyperpigmentation disorder that is more typically seen with prolonged use (6 months +) of high concentrations of hydroquinone (6-8%).

- More common and self-limiting side effects include skin irritation and redness.

- Patients are typically prescribed tretinoin 0.025% to 0.1% cream to apply at night, just before bed, during hydroquinone breaks.

- Additional agents often co-prescribed used in the mornings and afternoons include 10% niacinamide, ascorbic acid 15-20% and azelaic acid, Other agents such as licorice root extract and topical tranexamic acid (in an appropriate penetrating base) are also often seen prescribed.