Hydroquinone
Drug class: Antineoplastic Agents
Usage of Hydroquinone
Hyperpigmentation
Used to reduce hyperpigmentation in conditions such as freckling (ephelides), inactive chloasma, melasma, generalized and senile lentigo, and other unwanted areas of melanin hyperpigmentation.
Used for gradual treatment of ultraviolet-induced dyschromia and skin discoloration resulting from the use of oral contraceptives, pregnancy, hormone replacement therapy, or skin trauma.
Most clinicians consider hydroquinone to be useful in some patients with hyperpigmentation in which a large excess of melanin is not being produced.
Has been used to reduce hyperpigmentation caused by photosensitization associated with inflammation or with the use of certain perfumes.
Used in combination with fluocinolone and tretinoin for short-term and intermittent long-term treatment of moderate to severe melasma.
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How to use Hydroquinone
General
Administration
Topical Administration
Apply topically to the skin as a cream, gel, emulsion, or solution. (See Sensitivity Reactions under Cautions.)
Limit application to an area equal to that of the face and neck or hands and arms.
For dermatologic use only; avoid contact with eyes. If such contact occurs, flush the affected eye(s) with copious amounts of water and contact a clinician.
Not for oral administration.
Apply hydroquinone cream, gel, emulsion, or solution (with or without sunscreens) uniformly to pigmented area and rub into skin. Do not rub cream containing opaque sunblocking agents (e.g., talc) into the skin.
If hydroquinone preparations without sunscreen agents are applied during the daytime, use sunscreen agents and/or protective clothing to minimize exposure and prevent repigmentation of treated areas; alternatively, apply these preparations only at night.
Gently wash face and neck with mild soap, rinse, and pat dry before applying fixed-combination hydroquinone, fluocinolone, and tretinoin cream to affected area(s).
Apply a small amount of fixed-combination hydroquinone, fluocinolone, and tretinoin cream to affected area(s), including about ½ inch of normal skin surrounding each lesion. Rub lightly and uniformly into the skin. Do not use occlusive dressing.
Dosage
When the desired degree of depigmentation is obtained, apply only as often as needed to maintain depigmentation.
Pediatric Patients
Hyperpigmentation TopicalAdolescents >12 years of age: Apply hydroquinone cream, emulsion, gel, or solution (with or without sunscreens) uniformly to pigmented area(s) and rub in well twice daily, in the morning and evening.
If improvement does not occur after 2 months of treatment, discontinue the drug.
Adults
Hyperpigmentation TopicalHydroquinone cream, emulsion, gel, or solution (with or without sunscreens): Apply uniformly to pigmented area(s) and rub in well twice daily, in the morning and evening or as directed by a clinician.
Hydroquinone cream with opaque sunblock: Apply uniformly to the pigmented area(s) twice daily, in the morning and evening; do not rub into affected area(s).
If improvement does not occur after 2 months of treatment, discontinue the drug.
Melasma TopicalFixed-combination hydroquinone, fluocinolone, and tretinoin cream: Apply a thin layer uniformly to the affected area(s) once daily, in the evening, at least 30 minutes before bedtime. Continue daily for as long as the melasma lesions persist. Discontinue treatment when melasma resolves.
If melasma reoccurs, repeat treatment until condition resolves.
Prescribing Limits
Pediatric Patients
Hyperpigmentation TopicalAdolescents >12 years of age: Maximum 2 months of therapy if no improvement is seen.
Adults
Hyperpigmentation TopicalMaximum 2 months of therapy if no improvement is seen.
Melasma TopicalFixed-combination hydroquinone, fluocinolone, and tretinoin cream has been safely administered for cumulative ≥180 days.
Special Populations
Geriatric Patients
Clinical studies of 4% hydroquinone cream did not include sufficient number of patients ≥65 years of age to determine whether they respond differently from younger patients. In general, dosage selection for geriatric patients should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy.
Warnings
Contraindications
Warnings/Precautions
Warnings
Cosmetic EffectsMay produce undesired cosmetic effects (e.g., excessive skin bleaching) if not used as directed. Clinician should be familiar with the use, adverse effects, precautions, and contraindications before prescribing or dispensing the drug.
Exposure to Sunlight or Ultraviolet LightExposure to sunlight or ultraviolet light may cause repigmentation of bleached areas. Avoid unnecessary exposure to sunlight during and after therapy.
Sunscreen agents and/or protective clothing recommended if preparations which do not contain sunscreen are applied during the daytime. Preparations containing sunscreen may provide sufficient protection from sunlight.
After reduction of hyperpigmentation and during maintenance therapy, continue the use of sunscreen agents and/or protective clothing.
Sensitivity Reactions
Sulfite SensitivitySome formulations contain sulfites, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.
Other Sensitivity ReactionsContact dermatitis reported. If contact dermatitis occurs, discontinue immediately and contact a clinician.
Major Toxicities
Rarely, ochronosis (gradual blue-black darkening of the skin) and colloid milium reported with chronic use (up to 8 years) of 5% hydroquinone cream. If affected skin changes to a blue-black color, discontinue immediately and contact a clinician.
General Precautions
Topical UseFor external use only. Notfor topical application in the eyes, ears, or mouth; to cut, abraded, or sunburned skin; after shaving or using a depilatory agent; or over miliaria rubra (prickly heat).
Dermatologic EffectsPossible local skin irritation (e.g., burning, stinging, mild erythema). Dryness and fissuring of paranasal and infraorbital areas reported.
Use of Fixed CombinationsWhen hydroquinone is used in fixed combination with topical sunscreens (e.g., dioxybenzone, oxybenzone, and padimate), fluocinolone, or retinoids (e.g., tretinoin), consider the cautions, precautions, and contraindications associated with these agents.
Specific Populations
PregnancyCategory C.
LactationNot known if topical hydroquinone is distributed into milk. Caution advised if topical hydroquinone is used.
Pediatric UseSafety and efficacy of hydroquinone preparations not established in children <12 years of age.
Safety and efficacy of the fixed-combination hydroquinone, fluocinolone, and tretinoin cream not established in pediatric patients of any age.
Common Adverse Effects
Mild skin irritation and sensitization (e.g., burning, erythema, stinging).
Disclaimer
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