Since Melasma is Best Treated with Hydroquinone Cream, What is the Strongest Stength That Can Be Purchased with a Prescription?

Question

I have a hydroquinone 4 percent is there anything stronger?

S. Larry Schlesinger, MD, FACS · Answer

I have been treating Melasma for several years with a cream that I invented with a compounding pharmacy in Hawaii.  Although we put hydroquinone as an ingredient in our cream, the key ingredient is Kojic acid.  I believe Kojic acid is a much better specific treatment for Melasma as it does not give you the halo effect often seen with hydroquinone since it specifically targets the mask of pregnancy.  My pharmacist needed a name for this cream and so he calls it "Schlesinger's Melasma Cream".

Harold J. Kaplan, MD · Answer

Hello Elsie.  Yes, there are stronger prescription formulations than 4% hydroquinone and you can see the excellent results we get with our higher strength (up to 8%) product by clicking on the link to our website below.

	Anything over 4% is a compounded product, which means the formulation is determined by the medical office and the compounding pharmacy.  In addition to using up to 8% HQ, we do not include Retin A in our formulation because it irritates many of our patients.  Because it is dispensed in a liquid form, it penetrates more easily and yields better results.

	We have offices in Torrance and Orange, CA and would be happy to meet with you for a free consultation to discuss your condition.

Anteneh Roba, MD · Answer

HQ 4% is what is commonly prescribed in the US, however in my experience and especially in darker skinned individuals, 4%HQ even in combination with other products including tretinoin,kojic acid or steroids does not do the trick especially if the melasma is deep. Excellent results are achieved when using cosmelan 1 and 2 which contain 8% and 6% HQ respectively.  
does not do the trick

Apratim Goel, MD · Answer

of course hydroquinone on prescription can be bought upto 12 %. Infact brand MD products in USA have this percentage. However dont blindly  believe that higher the strength, it will erase the melasma faster.

Michele S. Green, MD · Answer

We have been compounding Hydroquinones from our office in as much as 8 percent.  I often combine it with Retin-A cream to best treat facial melasma.  Our patients do best when these products are combined with chemical peels to remove dark spots and melasma.  Please consult a board certified dermatologist who is an expert in chemical peels and melasma.  Best, Dr. Green

Mark Taylor, MD · Answer

A new effective, published treatment is available for melasma with a full-face iontophoresis mask using vitamin C and M2 (mandelic/malic acid) skin care. This may be used alone or in combination with a new low-energy Q-switched ND;YAG laser treatment. This treatment is safe and effective for all skin types. The article on this treatment was published in the Journal of Drugs in Dermatology in January 2013. The web reference link is included below. In my opinion this is a much safer treatment and more effective long term than hydroquinone

Channing R. Barnett, MD · Answer

Hydroquinone is a topical bleaching agent that is typically prescribed at a strength of 4% but which can be prescribed up to as strong as 8%. While effective usually on its own, it is typically more effective when mixed with tretinoin and mild cortisone. In addition to topical treatments and strict sun avoidance, other treatments which improve melasma are chemical peeling and laser. I recommend you consult with a board-certified dermatologist to discuss what combination of treatments will serve you best. But most important is sun avoidance!

Martie Gidon, MD, FRCPC, FAAD · Answer

Hydroquinone is usually mixed together with tretinoin and mild cortisone creams to be most effective. Up to 8% is usually prescribed. Your melasma should be assessed by a board certified dermatologist to see which treatments would be best for you. Often fading creams are combined with chemical peels and fractional laser treatments to effectively treat melasma. You must use sun protection and avoid sun exposure.

Leonard T. Yu, MD · Answer

Though there may be stronger hydroquinone formulations available, the advantage of the Obaji system is that the effectiveness of the treatment is enhanced by the other agents in the program and does not rely only on the concentration of the hydroquinone...effective melasma treatment relies on attacking this from several angles...

F. Victor Rueckl, MD (in memoriam) · Answer

4% is pretty standard for most products that include HQ, like the Obagi line. Specific formulations for straight hydroquinone cream can be called directly into a compounding pharmacy by your dermatologist and made especially for you. Most of these will be 8%, 12%, or even higher. The best part of straight hydroquinone compounds - most of these are actually cheaper than the 4% products and work much, much better!

Since Melasma is Best Treated with Hydroquinone Cream, What is the Strongest Stength That Can Be Purchased with a Prescription?

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