Most Medicare and insurance programs cover Tri-Luma. Combinations of melanin production inhibitors, retinoids, and corticosteroids are compared.
Is Tri-Luma a prescription?
Important facts to remember: TRI-LUMA Cream is for external usage only.
only. TRI-LUMA Cream should not be used in the mouth, eyes, or vaginal area.
TRI-LUMA Cream has been linked to birth abnormalities and mortality in children.
If used during pregnancy, the baby will be born. The possibility of birth abnormalities or death.
If TRI-LUMA Cream is taken during the first trimester of pregnancy, the baby’s chances of survival are better.
pregnancy. If you are pregnant or plan to become pregnant, tell your doctor.
TRI-LUMA Cream is a prescription cream that is used to treat a variety of skin conditions.
Treatment of moderate to severe melasma of the face for a short period of time, in combination with other treatments
Sun protection and the usage of sunscreens are recommended.
It’s unclear whether TRI-LUMA Cream is both safe and effective.
People with dark brown to black skin are more likely to have this condition.
It’s unclear whether TRI-LUMA Cream is both safe and effective.
in the treatment of dark spots on the skin (hyperpigmentation) caused by
Melasma is a type of melasma that affects the face.
It’s unclear whether TRI-LUMA Cream is both safe and effective.
Females who are pregnant or breastfeeding are at a higher risk. Look into it “What is the most important factor?
Is there anything more I should know about TRILUMA Cream?” in addition “What exactly is it?
Should I consult with my physician before taking TRI-LUMA Cream?”
If you are allergic to TRI-LUMA Cream, do not use it.
any of the TRI-LUMA Cream components A list of resources can be found at the conclusion of this leaflet.
TRI-LUMA Cream’s complete ingredient list.
are expecting a child or plan to have a child See “What is the Situation?”
“What is the most crucial thing I should know about TRI-LUMA Cream?”
are breastfeeding or intend to nurse their children. It is unknown.
if TRI-LUMA Cream is found in your breast milk Skin-to-skin contact should be avoided.
touch between TRILUMA Cream-treated regions and your infant
Inform your doctor about all of the medications you’re taking.
prescription and over-the-counter medications, vitamins, and herbal remedies
You use vitamins and skin care items.
Wash your face lightly before applying TRI-LUMA Cream.
Using a gentle cleanser After rinsing your face, pat it dry.
Apply a thin layer of TRI-LUMA Cream to the area that has been affected.
areas. Surround the afflicted area with about 1/2 inch of normal skin.
Avoid getting TRI-LUMA Cream around your mouth’s corners.
open wounds, your nose, or your eyes
You should stay away from the sun, sunlamps, tanning beds, and
UV light during TRI-LUMA Cream therapy
Use a 30 SPF (sun protection factor) sunscreen.
maybe even more. If you must be in the sun, don a hat with a wide brim or something similar.
Protective garments to cover the parts that have been treated.
Even a modest amount of sunlight can aggravate melasma.
sunshine. Continue to avoid direct sunlight, apply sunscreen, and wear protective clothing.
After using TRI-LUMA Cream, wear protective clothing.
Hormonal ways of birth should be avoided by females.
control. Melasma can be exacerbated by hormonal birth control techniques.
Other birth control choices should be discussed with your doctor.
Heat and cold can affect skin that has been treated with
TRI-LUMA. Consult your doctor for advice on how to deal with skin irritation.
Symptoms of allergies TRI-LUMA Cream may induce allergic reactions.
Allergic responses that are potentially fatal. TRI-LUMA Cream should be avoided at all costs.
If you experience any of the symptoms listed below, contact your doctor or seek medical care straight away.
symptoms:
a shift in skin tone TRI-LUMA contains one of the medications.
Cream can darken your skin to a blue-black color. TRI-LUMA Cream should be avoided.
Please notify your doctor if your skin darkens to a blue-black color.
TRI-LUMA Cream is a water-based cream that can travel through your skin. Too
If you have too much TRI-LUMA Cream on your skin, it can cause your adrenal glands to malfunction.
Stop what you’re doing. Your doctor may order blood testing to see if you have an adrenal gland problem.
issues.
If any adverse effect troubles you, tell your doctor.
It doesn’t matter if it’s you or something else.
These aren’t all of TRI-probable LUMA’s negative effects.
Cream. Ask your doctor or pharmacist for more information. Make an appointment with your physician.
in order to get medical advice about possible side effects. You can contact the FDA at 1-800-FDA-1088 to report side effects.
You can also contact Galderma to report side effects.
Call 1-866-735-4137 to reach Laboratories, L.P.
Medicines are sometimes administered for reasons other than those listed above.
Those listed in a Patient Information leaflet are different. TRI-LUMA Cream should not be used.
It was prescribed for a condition for which it had not been prescribed. TRI-LUMA Cream should not be given to children.
other individuals, even if they are experiencing the same symptoms as you. It has the potential to hurt them.
Talk to your doctor if you need further information.
doctor. You can get more information about TRI-LUMA from your pharmacist or doctor.
This is a cream that has been written for medical professionals.
Butylated hydroxytoluene, butylated hydroxytoluene, butylated hydroxytoluene, butyl
glycerin, glyceryl stearate, magnesium, cetyl alcohol, citric acid anhydrous
PEG-100 stearate, aluminum silicate, methyl gluceth-10, methylparaben
propylparaben, sodium metabisulfite, stearic acid, and stearyl alcohol
alcohol
The United States Food and Drug Administration has approved this Patient Information.
FDA stands for Food and Drug Administration.
How long does it take Tri-Luma to work?
Before you start using this product, and every time you get a refill, read the Patient Information Leaflet issued by your pharmacist. Consult your doctor or pharmacist if you have any concerns.
Apply a little dose of this drug to an unbroken patch of skin before using, and monitor the region for any major adverse effects within 24 hours. If the test area becomes itchy, red, swollen, or blistered, discontinue use and consult your doctor. If there is only mild redness, this product can be used to treat it.
Wash your face and neck lightly with a mild soapless cleanser before using. Rinse the skin and pat it dry.
Once daily, 30 minutes before sleep, apply a thin coating of medicine to the affected area, including about 1/2 inch (1.5 cm) of normal-appearing skin around the affected area, or as instructed by your doctor. Gently and thoroughly rub the drug into the skin. If your doctor tells you to, don’t bandage, cover, or wrap the affected region.
This drug may increase the sensitivity of the skin’s treated parts to the sun. Excessive sun exposure, tanning facilities, and sunlamps should all be avoided. When outdoors, use a sunscreen with an SPF of 30 or higher and wear protective clothes on the treated areas of skin, even on cloudy or hazy days.
If you have dry skin after using this product, apply a skin moisturizer after washing your face in the morning. While using this medication, you may apply a moisturizer and cosmetics during the day.
Avoid getting this product in your eyes, on your nose, or in your mouth. If you acquire this medication in certain locations, make sure you rinse it out with a lot of water. If you experience extreme irritation, seek medical help right away.
To receive the best benefit from this drug, take it on a daily basis. Use it at the same time every night to help you remember.
It could take up to four weeks to detect a substantial difference. This medicine, on the other hand, is not indicated for long-term use (e.g., more than 8 weeks) without taking a break. If your issue persists or worsens after 4 weeks of treatment, contact your doctor.
Does Tri-Luma need to be refrigerated?
Tri-Luma Cream is a pale yellow cream that comes in 30 g aluminum tubes with the NDC 0299-5950-30. Keep the container tightly closed when not in use. Refrigerate between 2° and 8°C (36° and 46°F). Protect yourself from the cold.
When do you stop taking Tri-Luma?
If you develop hives, severe itching, difficulty breathing, or swelling of your face, lips, tongue, or throat, seek emergency medical attention.
Worsening tiredness or muscle weakness; loss of appetite, diarrhea; weight loss or gain (especially in the face or upper back and torso); slow wound healing, thinning skin, increased body hair; changes in sexual function; depression, anxiety, feeling irritable are all possible signs of absorbing fluocinolone through your skin.
This is not an exhaustive list of potential adverse effects; more may arise. For medical advice on side effects, contact your doctor. You can contact the FDA at 1-800-FDA-1088 to report side effects.
Does melasma come back after Tri-Luma?
Melasma will most likely return if the underlying causes of the condition are not addressed, such as the use of certain birth control pills or excessive sun exposure. Most individuals who were treated with Tri-LumaCream (fluocinolone acetonide 0.01 percent, hydroquinone 4 percent, tretinoin 0.05 percent) for 8 weeks experienced their melasma return following treatment.
Tri-Luma Cream (fluocinolone acetonide 0.01 percent, hydroquinone 4 percent, tretinoin 0.05 percent) will help your melasma look better, but it’s not a cure.
How can I permanently cure melasma?
Hydroquinone is frequently used as the first line of treatment for melasma. Hydroquinone comes in a variety of forms, including lotions, creams, and gels.
The hydroquinone product can be applied directly to the darkened spots of skin.
Hydroquinone is available over the market, although stronger lotions can be prescribed by a doctor. Hydroquinone works by lightening the skin patches’ color.
Corticosteroids and tretinoin
Creams, lotions, and gels are used to apply corticosteroids and tretinoin. Both corticosteroids and tretinoin can aid in the lightening of melasma patches.
Combined creams
A dermatologist might prescribe a combo cream that contains hydroquinone, corticosteroids, and tretinoin all in one. Triple creams are what they’re called.
Additional topical medications
A dermatologist may prescribe azelaic acid or kojic acid in addition to or instead of other medicinal creams. These acids help to brighten dark spots on the skin.
Medical procedures
If topical treatments are ineffective, a dermatologist may suggest procedures like:
Some of these treatments have negative side effects or can lead to more skin problems. It is best to discuss any potential dangers with a doctor or dermatologist.
Does melasma come back after hydroquinone?
MAYO CLINIC, DEAR: I had some melasma areas on my face removed with IPL therapy years ago. When I went to see my dermatologist for the same problem lately, I was told that IPL should not be utilized for melasma. What is the reason for this? What kind of treatment should you use?
ANSWER: Your skin is in bad shape. Melasma can be difficult to entirely remove, and because it is a chronic illness, it can reappear after therapy. Melasma often emerges rapidly after the treatment you describe, intense-pulsed light or IPL. Intense-pulsed light can also cause the surrounding skin to heat up, which is thought to aggravate melasma. Sun protection, topical medicines, and cosmetic surgeries are frequently used in combination to treat melasma.
Melasma is a common skin disorder characterized by uneven areas of tan, brown, or brown-gray pigmentation on the face. Melasma strikes women far more commonly than it strikes men. Melasma is more likely to develop in those with darker skin.
UV rays from sun exposure is the most common cause of Melasma. Melasma can be caused by hormonal changes caused by pregnancy or certain drugs, such as oral contraceptives. According to recent study, blue light emitted by lightbulbs, computer displays, and other electronic gadgets can exacerbate melasma. Melasma tends to occur in families, indicating that it may have a hereditary component.
Because melasma can be mild and seem like other skin disorders, it’s vital to contact a dermatologist for a precise diagnosis when facialpigmentation first develops. Melasma treatment aims to reduce pigment production and remove regions of excess pigmentation that have already occurred once the condition has been diagnosed.
Melasma treatment with intense-pulsedlight utilises a broad spectrum of light to generate heat and target and remove pigment. However, the heat spreads to all surrounding tissues. This can lead to issues, such as post-inflammatory hyperpigmentation, which causes the appearance of new dark areas. Intense-pulsed light has been shown to improve melasma in the short term, but relapse is common within three months, according to research.
Fractional nonablative lasers have lately been investigated for the treatment of melasma. These lasers rejuvenate the skin and remove pigment using heated columns, however they do not affect the skin around the columns. Different devices with varying amounts of power are available, allowing each patient’s treatment to be tailored to their specific needs. Unlike intense-pulsed light, which has a fixed coverage of 100 percent, these lasers can treat as little as 5% of the skin to gently erase pigment with a significantly lower chance of relapse or aggravation of melasma.
However, when it comes to melasma treatment in general, topical treatment is the key to success. It should be administered before any light or laser operation, and it should be continued even if those methods are suggested to reduce the risk of relapse. The most often used lightening agent is topical hydroquinone. It works by reducing the amount of pigment produced. For enhanced efficacy, your doctor may suggest mixing it with tretinoin, corticosteroids, antioxidants, or other topical medicines. To remove pigment, superficial chemical peels may be used in some circumstances.
To prevent further melasma formation and to maintain treatment results, you must avoid sun exposure and protect your skin from the sun. When you’re outside, wear a wide-brimmed hat and sunglasses, and use sunscreen with a sun protection factor (SPF) of 50 or greater every day. The best sunscreen is one that contains a physical blocker, such as zinc oxide or titanium dioxide. Every one to two hours, reapply it.
Melasma therapy research is progressing. Melasma is linked to inflammation, skin barrier deterioration, and an increase in blood vessels, according to new research. These discoveries could lead to the development of novel treatment alternatives. Consult your dermatologist to learn more about upcoming topical and oral treatments. Dermatology, Mayo Clinic, Scottsdale, Arizona, Dr. Elika Hoss
Does pigmentation come back after hydroquinone?
For many people, hydroquinone is like an old friend who suddenly abandons them. They may have used it for years, believing that a dermatologistor, more commonly, an Internet pharmacywould never recommend a potentially harmful product.
However, some of these customers experience new pigment problems in areas where they have diligently used hydroquinone over time. They purchased a treatment to lighten sunspots, melasma, or other hyperpigmentation, but it left them with difficult-to-treat conditions including severe rebound hyperpigmentation and ochronosis.
To avoid such negative effects, we must change our approach to hydroquinone. My study and clinical experience have convinced me that hydroquinone should be used for no more than four or five months at a time by our patients. Then we must give the skin time to heal and stabilize before evaluating whether or not another course of hydroquinone is necessary. Pulsed Hydroquinone Therapy is the name I give to this method.
Medical Products Need Medical Supervision
Hydroquinone has always been a favorite of mine. It is safe and effective for pigment problems such as chloasma, melasma, and postinflammatory hyperpigmentation (PIH) when used in reasonable concentrations under physician supervision, as well as for preparing skin for treatment of less common concerns such as nevi of Ota and Huri, which require pigment laser.
However, over the last few years, the Internet has become flooded with low-cost, medical-grade products that companies offer straight to consumers without medical supervision or sun protection.
Consumers want to avoid paying a consultation fee or visiting a doctor. I don’t see anything wrong with ordering a simple moisturizer or broad-spectrum sunscreen from the comfort of my own home. However, continuing treatment with hydroquinone (or other medical-grade skin formulations) indefinitely without the supervision and expertise of the dermatologist who recommended it frequently results in dermatologic disasters.
The patterns I’m seeing more and more in my clinical practice, as well as the explanations behind them, are listed below.
Resistance. Some persons who have been using hydroquinone at a proper concentration of 4% (alone or in compounded formulations) have seen that their skin improves for a few months before plateauing. This is especially prevalent after four to five months of acceptable response in patients taking hydroquinone for melasma, in my experience.
The bleaching effects of hydroquinone are more pronounced in areas not affected by melasma in these circumstances. Meanwhile, melasma’s dark blotches aren’t becoming any lighter. In fact, the patient’s hyperpigmentation in these places worsens as the active melanocytes in the afflicted areas gain resistance to hydroquinone.
That’s what happened in 2001 to a 58-year-old Indian woman who was diagnosed with melasma at our clinic (see above, Patient 1). She was successfully treated with hydroquinone 4% and hydroquinone combined with retinoic acid at the time, followed by a chemical peel of the papillary dermis. After obtaining branded hydroquinone 4 percent and retinoic acid goods from the internet and the underground market a decade later, she returned and was diagnosed with rebound severe melasma (epidermal and dermal) that did not respond to treatment but was worse by her continued hydroquinone use.
To avoid such issues, I recommend that all patients stop using hydroquinone for two to three months after five months of use. This permits melanocytes to stabilize (so they can withstand external and internal influences that might otherwise cause them to become more active) and restore the skin’s natural melanin. Patients can take various lightening treatments during this time, then return to hydroquinone if necessary.
Increased hydroquinone concentration may be used by certain physicians to treat resistant melasma. Instead, I’ve discovered that patients respond well to a combination of hydroquinone (4%) and retinoic acid (50%) applied aggressively. This combination does not bleach the skin, but it does speed up the process of achieving a more natural and even color tone. After the skin’s hue has evened out after up to five months of treatment, I have my patients stop using this combination and switch to retinoic acid alone for two to three months; then they can restart using hydroquinone if needed.
Phototoxicity and photosensitivity are two terms that are used interchangeably. Certain topical drugs, such as retinoids and aminolevulinic acid, as well as some systemic pharmaceuticals (such as tobramycin/TCN and hydrochlorothiazide), have been shown to increase skin sensitivity to sunlight. Surprisingly, no one has ever considered hydroquinone to be a photosensitizer, to my knowledge.
Some patients believe that using hydroquinone continuously will prevent undesirable pigmentation. However, we now know that lowering melanin levels in the skin, as hydroquinone does, causes photosensitivity. Photosensitivity causes inflammation, which encourages melanin production, if you don’t use a sunscreen with a high sun protection factor (SPF) and reapply it frequently.
The sun can also have a direct effect on melanocytes, stimulating melanin synthesis and perhaps causing rebound pigmentation. Furthermore, phototoxic responses can result in a chemically changed bluish melanin complex, which causes ochronosis, a difficult condition to treat because it involves deep pigmentary changes deep in the dermis as well as altered skin texture.
Physicians used to think of ochronosis as a malady that only affected particular African tribes, and we thought it was caused partly by genetics and partly by long-term hydroquinone use.
However, in recent years, I’ve noticed an increase in the occurrence of ochronosis not only in African-Americans, but also in Caucasians, Asians, and Hispanics who have used varied amounts of hydroquinone for years. Ochronosis has developed in the parts of the face that receive the most sun exposure in these patients.
A 39-year-old Caucasian woman was one of the patients I saw. In the two years prior to appearing at our clinic with severe ochronosis, she had a history of melasma and had undergone the following therapies, as indicated by multiple dermatologists: In one year, patients received three peels containing azelaic acid, kojic acid, phytic acid, ascorbic acid, arbutin, and titanium dioxide (Cosmelan, Mesoestetic); eight intense pulsed light (IPL) treatments; three fractional laser resurfacing (Fraxel, Solta) sessions; six Jessner’s peels; and continuous use of hydroquinone 8% for two years.
This example also serves as a warning that exfoliative operations, chemical peels, laser resurfacing, and other thermal rejuvenating devices should not be used as the first step in addressing hyperpigmentation. Rather, I urge good skin conditioning for four to six weeks before and after any procedure, utilizing hydroquinone, hydroquinone plus retinoic acid, alpha hydroxy acids, antioxidants, and other disease-specific medicines as needed (once skin healing is complete). This aids in the restoration of normalcy and functionality to the skin, as well as improving the outcomes of treatments.
HQ concentration is excessive. I’m used to administering hydroquinone dosages of 4%, and I’ve seen a lot of patients who took high doses on their own or under the supervision of other doctors. Such amounts, based on my observations and experience, do not produce any better or faster results than hydroquinone 4 percent. Concentrations of 6-12 percent, on the other hand, tend to generate more stubborn hyperpigmentation, faster resistance, and a higher rate of ochronosis.
Excessive hydroquinone concentrations can cause melanocytes to become poisoned or shocked, prompting them to regroup and produce more melanin (resulting in rebound hyperpigmentation). Hydroquinone in high doses can also cause skin irritation. Hydroquinone is an inflammatory chemical that causes redness, irritation, and allergic responses when used alone. Inflammation causes melanocyte hyperactivity, which overcomes the ability of hydroquinone to reduce tyrosinase, resulting in rebound hyperpigmentation.
This was the situation with a 66-year-old African-American woman with a history of melasma who had been treated by various dermatologists for seven years (Patient 2). For years, she utilized hydroquinone 8%, tretinoin (Valeant Dermatology’s Retin-A), and desonide cream (Galderma’s Desowen). She was administered hydroquinone 12 percent after being dissatisfied with the outcomes, and her dermatologist added topical steroids to her regimen. After her condition worsened, she was referred to our office, where she was diagnosed with rebound dermal and epidermal hyperpigmentation, ochronosis, and acute irritation and sensitivity. We immediately stopped using hydroquinone.
Combination formulations using hydroquinone. In this regard, users may easily discover solutions that mix hydroquinone with retinoic acid, glycolic acid, vitamin C, and topical steroids, among other substances. However, long-term use of such products might exacerbate pigmentation and cause other problems. This is especially true with products that contain hydroquinone, retinoic acid, and steroids, such as Kligman’s formula and the hydroquinone, tretinoin, and fluocinolone acetonide combination (Triluma, Galderma). Long-term usage of these products has been shown to cause skin shrinkage, telangiectasias, skin sensitivity, and, in some cases, more obstinate pigmentation than the patient had before.
These formulations use topical steroids to reduce inflammation. This is crucial because inflammation stimulates the formation of melanin by melanocytes. Topical steroids, on the other hand, only function on pigmentation caused by trauma or disease (PIH). Topical steroids, on the other hand, should not be prescribed for people with pigment disorders that aren’t caused by inflammation, such as melasma.
Furthermore, according to the manufacturer’s instructions, these triple-combination medications should not be used for more than five to seven days to avoid disturbing cellular function. As an alternative, I favor a steroid-free combination of hydroquinone and retinoic acid. When used properly for three to five months with strict sun protection, it is both safer and effective.
Retinoids Require Caution
Many medical-grade chemicals, such as retinoic acid and other retinoids, can be useful for two or three months but subsequently produce chronic irritation, similar to hydroquinone. As the skin develops resistance to the treatment, irritation can lead to inflammation and further damage.
Patient 3 (picture above), a 59-year-old Hispanic woman with melasma, acne, and scarring, was successfully treated with topical creams, isotretinoin, and trichloroacetic acid peels in 1990. As previously mentioned, her maintenance therapy includes hydroquinone 4 percent and a hydroquinoneretinoic acid combination. She first came to the clinic with ochronosis on the left side of her face around five years ago (because she drives long distances). Her ochronosis is being treated at the moment.
Patient 4 (picture on previous page) is a 57-year-old African-American woman who was diagnosed with PIH and melasma 25 years ago. She reacted effectively to a topical therapy that includes 4 percent hydroquinone used twice a day and hydroquinone coupled with retinoic acid applied at night. A trichloroacetic acid peel was also performed down to the papillary dermis. She did not continue with her treatments after that, although she did return many years later. She had been using hydroquinone drugs for a long time and had developed ochronosis. I told her to cease taking the hydroquinone right away because she didn’t want to treat the ochronosis because it didn’t bother her.
Based on these experiences, I now consider retinoic acid to be a tool for general skin restoration; however, it is not always the best option. Retinoic acid is difficult to tolerate long-term for most patients because the fraction of the medicine that is not absorbed for skin healing remains on the skin’s surface, causing ongoing responses. These reactions might include redness, dryness, and exfoliation in addition to discomfort. These constant interactions can even break down the skin’s barrier function, causing skin sensitivity in some cases. Many patients stop taking retinoic acid because of these negative effects.
To avoid these complications, I now advise patients to take retinoic acid for no more than five months. That gives you enough time to restore your skin in general without triggering long-term skin responses. I move my patients to an agent with specialized skin-repair capabilities, such as retinol, after five months. It promotes barrier function while also stimulating and stabilizing normal to dry skin. Retinol is converted to retinoic acid intracellularly, therefore there is no free, unused retinoic acid on the skin’s surface to induce responses.
The examples described above have a lot in common. Despite the fact that each patient began therapy under the supervision of a doctor, they eventually obtained medical-grade hydroquinone and other medical-grade ingredients at great discounts from online and other unlicensed sources. Consumers were able to utilize these drugs without physician oversight for more than five years because they were readily available, typically from websites operated by physicians, pharmacies, or other businesses. As a result, I oppose the sale of medical-grade items over the internet for the aim of treating skin diseases without medical supervision. I believe the FDA should step in to put a stop to these activities.
In contrast, I feel that formulations that combine hydroquinone with botanical anti-inflammatory drugs and antioxidants that can control skin inflammation caused by variables like sun exposure, hormones, and food are highly effective in treating hyperpigmentation. Even nonsteroidal anti-inflammatory drugs like ibuprofen can hasten a patient’s response to hydroquinone. They accomplish this by stopping or reducing chronic skin irritation.
Adding vitamin C or glycolic acid to hydroquinone, on the other hand, does not, in my opinion, provide any additional scientifically verified benefits. Vitamin C and glycolic acid, in fact, can irritate the skin, causing irritation and aggravating hyperpigmentation (rebound hyperpigmentation).
Pulsed Regimen Reduces Risks
Finally, when used as advised by a physician, hydroquinone is safe and effective for a wide range of pigmentation issues. Dermatologists should follow the following regimen to maximize its efficacy and reduce undesired side effects:
- Allow two to three months for the skin to relax and heal following hydroquinone treatment.
Our patients will avoid the disfiguring and unnecessary side effects of long-term, self-directed hydroquinone use if we employ a pulsed strategy.