Prescription

Hydroquinone 1 %
Tretinoin 0.05 %
Kojic Acid 0.05 %
Hydrocortisone 0.05%

Hydroquinone 1%
Widely used for melasma therapy
Inhibits conversion of dopa to melanin by inhibiting the activity of

tyrosinase
Interferes with DNA and RNA synthesis
degrade melanosomes and destroys melanocytes

Side Effect Profile

Irritant Reactions ( 25% patients develops itchy eruptions)
Rare Allergic contact dermatitis
Nail bleaching

Note- Dont use monobenzylether or ethers of Hydroquinones to treat

melasma because they can lead to permanent loss of melanocytes
with the development of disfiguring confetti-like leukoderma.

Tretinoin 0.05 %
Reduces pigmentation by inhibiting tyrosinase

transcription
Also interrupts melanin synthesis
It also has anti-inflammatory properties
Used for Acne vulgaris and Facial wrinkles
Side Effect Profile
Excessive dryness
Erythema
Peeling
Stinging

Kojic Acid
Produced by the fungus Aspergiline oryzae
Tyrosinase Inhibitor
Inhibits the production of free tyrosinase

Used for treatment of hyperpigmentation

disorder
When it is combine with Hydroquinone
effectively reduces pigmentation
Combination therapy with Hydroquinone is
superior to Hydroquinone alone
Side Effect Profile
Erythema
Rare Contact Dermatitis

Hydrocortisone
Absorbed by skin cells and inhibits

macrophage accumulation in the inflamed

areas
Reduces fibroblast proliferation, collagen
disposition and subsequent scar tissue
formation
Helps with red scars
Side Effect Profile
Itching
Pigmentation changes
Acneform lesions

Combination Therapy
Used for bleaching of gradual bleaching of

Hyperpigmented skin conditions

Freckles, melasma, age spots and scars caused

by acne
More effective than single agents used alone
Therapies that act at different stages of

pigmentation can produce better clinical results

than a single therapy acting at a single stage

Continued
Addition of Tretinoin eliminates pigmentation

and increases keratinocytes proliferation by

preventing the oxidation of Hydroquinone and
improving epidermal penetration
Addition of topical corticosteroids reduces the

irritative effects of hypopigmentation and

inhibits melanin synthesis by decreasing
cellular metabolism

How This Can be Used ?

Applied topically to the affected area once

daily or directed by a doctor

Correct dosage and length of treatment
depends on patients condition and their
response to the therapy
Prior applying, wash and dry hands and the
affected area with water
Patient might see side effect such as dry skin,
erythema, stinging, irritation, itching or
burning at application site

References
Pandya AG, Guevara IL. Disorders of

Hyperpigmentation. Dermatology Clin. Jan

2000. 18(1):91-8
Jimbow K, Obata H, Pathak MA. Mechanism of
depigmentation by hydroquinone. Journal
Invest Dermatology. April 1974 62(4):436-49
Taylor SC, Torok H, Jones T , et al. Efficacy and
Safety of a new triple combination agent for
the treatment of facial melasma. Curtis. July
2003. 72(1):67-72.