Hydroquinone

About Hydroquinone

Plain 4 percent creams are labeled for the gradual lightening of darkened skin such as melasma (chloasma), freckles and age spots. They are applied twice a day, morning and bedtime, after a test on a small patch of unbroken skin checked within 24 hours, and are stopped if there is no lightening after two months. Tri-Luma, which combines the steroid fluocinolone acetonide with hydroquinone and tretinoin, is approved for short-term treatment of moderate to severe melasma of the face, together with sun avoidance and sunscreen. A thin film goes on once a day, at least 30 minutes before bedtime, over the patches and about half an inch of skin around them. It is not for maintenance, and melasma usually returns after stopping.

Hydroquinone can cause exogenous ochronosis, a gradual blue-black darkening of the skin, reported mostly in Black patients but also in others; treatment stops if it appears. Tri-Luma contains sodium metabisulfite, a sulfite that can cause serious allergic reactions, including severe asthma attacks, in susceptible people. Redness, peeling, burning, dryness and itching are common with Tri-Luma, and its steroid can be absorbed enough to suppress the adrenal glands. Safety in children has not been established, and the plain creams are not for children under 12 except under a doctor’s supervision. In pregnancy, Tri-Luma’s label advises use only if the benefit justifies the risk to the fetus, and the plain cream labels only if clearly needed; Tri-Luma’s label adds that a nursing baby should not touch treated skin.

Sun protection is part of the treatment: sunlight can bring the color back, so a broad-spectrum sunscreen or protective clothing is used every day during treatment and any maintenance treatment, and Tri-Luma’s label asks for SPF 30. No generic of Tri-Luma has been approved, and it is kept in the refrigerator. Plain 4 percent creams are sold under many names by different labelers, and their listings typically show them marketed as unapproved drugs, outside the Orange Book. They are not rated as equivalent to one another, and some contain a sunscreen, so the exact product on the prescription matters.

Taking Hydroquinone

How to take it

Before the first use of a plain cream, test a small amount on unbroken skin and check it within 24 hours. Apply the plain cream only to the dark areas, morning and bedtime, and rub it in; apply Tri-Luma once a day, at least 30 minutes before bedtime, to a face washed with a mild cleanser and patted dry. Keep both away from the eyes, nose and mouth, and use sunscreen every day.

If you miss a dose

Apply it when you remember, unless the next application is nearly due; then skip the missed one. Never apply two doses at once.

Storage

Keep Tri-Luma in the refrigerator, tightly closed and not frozen. Keep plain creams at room temperature, tightly closed. Store both out of reach of children.

Interactions to know about

Benzoyl peroxide and hydrogen peroxide products can stain treated skin, and harsh soaps, astringents and alcohol-based products add to irritation. Tri-Luma calls for caution with medicines that make the skin more sensitive to light. Tell the prescriber about a sulfite allergy or asthma.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Hydroquinone differs from pharmacy to pharmacy

Tri-Luma is sold only as a brand and is stored in the refrigerator, so it is priced as a brand and a pharmacy that does not keep it may need to order it. Plain 4 percent creams come from several labelers, each with its own product, so quotes depend on which product a pharmacy carries.

Because the plain creams are not rated as equivalent to each other, a prescription that names one particular product can limit which pharmacies can fill it as written.

Ways to pay less for Hydroquinone without insurance

• If Tri-Luma is prescribed, ask the maker whether a savings program applies to someone paying cash; many copay cards require commercial insurance.
• Ask the prescriber whether a plain 4 percent cream would suit you, and whether the prescription can be written so the pharmacy may use the product it stocks.
• Ask for one tube at a time until you know how your skin responds; the plain cream labels say to stop if there is no lightening after two months.
• Compare more than one pharmacy, and confirm which product each one is quoting.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Hydroquinone

1. 1.Which hydroquinone product is on my prescription, and does it contain a sulfite or a sunscreen?
2. 2.How should I do the skin test before I start?
3. 3.Which sunscreen should I use, and for how long after treatment?
4. 4.What should I do if my skin turns blue-black or very red?

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