Archives For cosmetic drugs



If any pill has the potential to improve the appearance of your skin it’s going to be vitamin C….in my opinion. It is essential for collagen syntheses. Collegen is connective tissue and the substance that makes skin look plump and full. In the presence of vitamin C deficiencies people develop wounds that do no heal properly. Healing is rapidly achieved when the deficiency is corrected.


In addition to having the potential to increase the thickness of the skin, vitamin C also has the potential to unify the skin color. Some experts categorize it as a skin bleach….wikipedia.


Vitamin C is the substance that keeps fruits and vegetables from tarnishing and becoming discolored when cut open and exposed to air. It’s a complicated process called biochemistry, but basically vitamin C donates an electron to atoms and molecules in desperate need of one. And for that reason, vitamin C enhances the absorption of iron from the stomach into the blood stream. Very important for people with iron deficiency anemia and blood loss.


Vitamin E is another pill with the potent to improve the skin. Similar to vitamin C, it prevents the discoloration and deterioration of meat. It is applied to meat sold in the grocery stores and keeps the produce pink and fresh looking. Without it the meat would turn a bluish gray.


Vitamin E is also added to fish oil capsules to prevent the oil from becoming rancid.


So it may came as no surprise that many topical skin products contain vitamin C and E. And there are studies proving their goodness, especially vitamin C.


But what would happen if you took these vitamins in a pill form?


Well, there are two studies that tested both these pills together short term and the results were astounding to me. Taking a combination of both vitamin C and vitamin E supplements ORALLY 2 grams of vitamin C along with 1000 IU oral vitamin E before sun exposure, reduced skin inflammation after sun exposure.4715,4716


Could these pills prevent photo aging? Possibly, since the main source of skin damage is from the sun, it makes sense, but I wouldn’t use these pills in place of sunscreen.


However, there are some commercially available products on the market that claim to be sunscreen in a pill. Basically they are combinations of vitamins C, E and A. If you don’t know it yet, vitamin A is dangerous and should only be prescribed by an eye doctor or skin doctor because it caused cancer in smokers. However, it is good for the skin and eyes. That’s another blog….subscribe and I’ll explain later.


There is also a new an antioxidant pill made from a fern that protects from the sun. It’s called Heliocare and we are still discovering how it works and what side effects it has.


But I would caution people that these pills have consequences. Vitamin C in high doses can cause nausea, vomiting, diarrhea and kidney stones. Vitamin E has been linked to an increase in prostate cancer and hemorrhagic strokes. But lots of people are willing to take their chances in pursuit of beauty, and I totally understand that. If you’re that kind of person you might also want to look into DHEA. DHEA is a pill and has been studied in relation to improving the skin and I will reveal those studies in a future blog along with much more. Stay tuned. Subscribe!



Topical Vitamin C: Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg. 1999;125:1091-1098.



Fuchs J, Kern H. Modulation of UV-light-induced skin inflammation by D-alpha-tocopherol and L-ascorbic acid: a clinical study using solar simulated radiation. Free Radic Biol Med 1998;25:1006-


Eberlein-Konig B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol 1998;38:45-







One third of all deaths are caused from blood vessels “giving out”. Either they clog up or they break open. When this happens it’s called a stroke, heart attack, aneurism, or sudden death. Strokes are particularly scary because they leave people debilitated and partially paralyzed.

Most often these events happen without warning. They are silent killers because we can can’t see them developing. If we could see inside the vessels that carry life sustain nutrients to our brain and other vital organs becoming red, inflamed, hardening, scaring, tearing, thinning, scabbing over with plaque, and breaking would be compelled to take sudden and aggressive action? If there was a drug to prevent this, would you take it?

If there was a drug to prevent this, would you take it? Well there is a drug that when given to 48 patients with heart disease for 3 to 5 years it will consistently prevent one death in that group that normally would have happened if left untreated. This drug is proven to save the lives. But what if you don’t have heart disease? What if you just want to avoid a heart attack, stroke, or just live longer? Well, treating about 60 patients at risk for heart disease with this drug for 4 years consistently prevents one NON-fatal heart attack or stroke.

It’s Important to know who is at risk because those people benefit the most. They are people with extremely high LDL cholesterol, middle-aged people with type 2 diabetes, people with smoking habits, and those who use blood pressure medicines. Also, men and women 40 to 75 who have an estimated 10-year risk of heart or blood vessel problems of 7.5% or higher according to this website:

Before I tell you the name of this drug, let me just say that if you have been reading my blogs you know that in my opinion all drugs are good and bad depending on the situation. Most things in life are that way. Always gray, never black or white. Even water and oxygen are bad in excessive amounts. If you drink too much water it causes electrolyte imbalances, if you consume too much oxygen, your blood chemistry goes off.

This drug, rather this group of drugs, in my opinion is an extreme case of both good and bad. The group of drugs is called Statins. Specific names for these products are called, advicor, atorvastin, rosuvastatin, crestor, lescol, fluvastain, Lipitor, pitavastatin, livalo, mevacor, lovastatin, prachol, pravastatin, mevacor, lovastatin, Zocor, simvastatin.

Time for some bad news: the number one side effect of this drug is muscle pain much like the feeling after you have just run a marathon. The spectrum ranges from the more common but less severe myalgia (5%-10%) to the less common but more severe myopathy (0.1%) and its potentially fatal complication, rhabdomyolysis (0.01%).

Fortunately there are steps to ward off these effects: optimize your vitamin d levels with a supplement, and take coenzyme Q10. If you have any muscle fatigue or pain I recommend talking to your doctor about switching to another statin drug and/or taking the drug every OTHER day.

Remember these drugs save lives so don’t ever take yourself off this or any drug that is prescribed by a medical doctor. It’s worth repeating.

In the West of Scotland Coronary Prevention Study of men without a history of coronary artery disease, the risk of all-cause mortality was reduced 33% more among those who took 75% or more of their prescribed medication compared with those taking less than 75%.

These drugs are also being studied to preserve eyesight, prevent osteoporosis, reduce inflammation, protection of the kidneys when exposed to radioactive contrast dye, prevention of blood clots, and much, much more. It is even used in Progeria, the premature aging disease of young children who look like they are very elderly.

No other drug group can claim all that. Statins are the closest thing to an antiaging medical miracle that is on the market today.

So, How do fish oils and niacin compare? They lower triglyercerides, and niacin also increases the good cholesterol HDL. But does having the right numbers translate into fewer heart attacks and strokes? If you gave someone an infusion of HDL good cholesterol, will they be healthier? No! They will develop liver problems. Good numbers without the lifestyle to produce them does not mean you are healthy.

The FDA won’t even allow the prescription omega3 product to claim that it reduces the incidence of heart attack or stroke. The only thing this product is allowed to claim is that it lowers triglycerides.

Just recently, November 2013, medical experts lowered the criteria for taking a statin. More people are now eligible for this life extending drug if they chose to take it. A lot of people criticized this decision but would you rather be denied access to it? Or would you rather be allowed to make an educated decision with your doctor as to whether it is right for you?

Stay tuned for drug interactions with statins that can trigger muscle problems and other less common side effects caused by statins. It’s important to get the whole story. You might even want to subscribe to this blog so you don’t miss it or any other articles similar to this….POWER TO THE PEOPLE!

imagesCAW89QCFIf you have been reading my blogs you know that I prefer prescription drugs over supplements because prescriptions drugs are standardized and tested to be safe and effective. Supplements are not. The down side to prescription weight loss drugs is that you need permission from your doctor and your insurance may or may not pay for them. Be prepared to pay cash for them and and get a price quote. Insurance will most likely pay for antidepressants and diabetic medications that double as weight loss medications. See the list below.

The diabetic medications exenatide and liraglutide have been tested in diabetics and non diabetics according to this review of several studies publihed by Vilsboll T, Christensen M, Junker AE, et al. Effects of glucagon-like peptide-1 receptor agonists on weight loss: Systematic review and meta-analyses of randomized controlled trials. BMJ 2012; 344:d7771. However, these diabetic medicines work slowly and consistently over time. If your doctor prescribes a diabetic medication, you might want to ask her if you can try these first because some diabetic medications cause weight gain. Stay tuned for the blog on drugs that make you gain weight.

Antidepressants have the pleasant side effect of elevating your mood as well as helping you lose weight. But not all antidepressants cause weight loss, some cause weight gain. Doctors a lot of times will let you try various antidepressants to see which ones resolve your symptoms, so it’s good to know which ones cause weight gain. I will include those medications in the future blog on drugs that make you fat and alternatives to ask your doctor about.

My number one recommendation for prescription weight loss is Bupropion. Originally marketed as an antidepressant, it’s used to treat any sort of addictive behavior like smoking, bulimia, and cocaine dependance. It’s important to do your research before asking your doctor for a prescription. In addition to checking the cash price, I’d also print out the prescribing information for your doctor incase she asks for it. I also recommend you read the patient information on the website MedlinePlus. I like this website for patient information because they do not have tricky advertisements disguised as news information.

After doing the necessary research I’d gently bring up the subject and say something like….”Dr., as you know I’ve been struggling with my weight/elevated blood sugar/elevated blood pressure/sleep apnea, and I was wondering if one of the following drugs might help me in my efforts to lose weight.” Then I would produce the following list of medications. The average wieght loss of these medications was formulated based on the article by LeBlanc ES, O’Connor E, Whitlock EP, et al. Effectiveness of primary care-relevant treatments for obesity in adults: A systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2011; 155:434. which reviewed 6498 abstracts and 648 articles.

If your doctor does not prescribe a medications listed below, ask her if you can take a dietary supplement listed in a previous blog of mine called Dietary Supplements That Make You healthier Than Ever. But whatever you do, don’t give up the good fight to stay healthy and fit. There is help.

The following are a list of prescription weight loss drugs, the average amount of weight loss during the study, and important information regarding that drug.

  1. Orlistat (Alli) ≥1 year was 5.3 kg  (11lbs 10oz) Prevents the absorption of fat. FYI:wear a diaper due to uncontrollable fatty diarrhea. Take three times per day, taken with a meal; you can skip a dose if you skip a meal or if the meal contains no fat.
  2. Fluoxetine (Prozac) at 24 weeks there was a 4.8 kg (10 lbs 9oz) weight loss. Originally an antidepressant.
  3. Bupropion (Wellbutrin)***my #1 recommendation. At 24 weeks there was 8.0 kg (17lbs 10oz) weight loss. Originally an antidepressant, helps with food cravings and also used to quit smoking.
  4. Bupropion and Naltrexone combined (Contrave) at  ≥1 year there was a 8.7 kg (19 lbs  2 oz) weight loss. Each ingredient sold separately. Can cause constipation even though it is NOT a stimulant.
  5. Exenatide (Beyetta) At 24 weeks there was 2.9 kg (6 lbs 6 oz) A diabetic medication. Requires injection, frequent GI side effects, long-term safety not established, expensive.
  6. Liraglutide (Victoza)  At 24 weeks there was a 2.8 kg (6 lbs 2 oz) A diabetic medication. Requires injection, frequent GI side effects, long-term safety not established, expensive
  7. Metformin (Glucophage) At 1 year there was an average weight loss of 2.8 kg (6 lbs 2 oz) originally a diabetic medication, GI side effects, contraindicated with renal insufficiency, can throw-off your body chemistry.
  8. Lorcaserin (Belviq)     1 year -5.8 kg (12 lbs 12 oz) increases happy hormones in brain, do not take with stimulants or antidepressants. do not take if have kidney problems.
  9. Phentermine (Adipex, Qsymia) at 13 weeks there  was a 6.4 kg (14lbs 1 oz) weight loss: stimulant, increase in blood pressure, heart rate, dry mouth, constipation, insomnia…this is true for all stimulants. see below. It is also a controlled substance.
  10. Diethylpropion (Tenuate) at 18 weeks there was a 6.5 kg  (14 lbs 5 oz) weight loss. It is a stimulant, controlled substance.
  11. Mazindol (Sanorex, Mazanor) at 11 weeks there was 5.7 kg (12.9 lbs oz) weight loss. It is a stimulant and controlled substance.
  12. Phen/Topiramate (sold separately Adipex and Topamax)    ≥1 year -10.2 kg (22 lbs 7 oz) phen is a stimulant, topiramate originally used for seizures and headaches, do not stop suddenly or you can get a seizure. causes birth defects,

images5The promised blog on diet pills.

In a previous blog you might recall me saying that a feel bad for people who have given up on trying to loose weight and be healthy, but there are pills to help and encourage them. This blog is about those pills.

There are so many, where shall I start.  I’ll divide them into two categories.  Those requiring a prescriptions and those that do not require a prescription. The pills that do not require a prescriptions can be divided again into two groups- those you can live on and those that should be used for the least amount of time possible. And the reasons vary as to why you want to get off of them asap. Number one reason in my opinion is because they are not tested for contaminants and you never know for sure what is in them. If you read my blog the down side of vitamins, you’ll discover all the things that can go wrong. It’s scary. People developed hepatitis, kidney failure, cancers, some even died from the contaminants alone. Most the contaminated products come from Asia and India an they are herbal concoctions. However, there was one product from Brazil that had amphetamines in it and a guy tested positive for it at his job. That could ruin a person’s life so fast. You might never be able to shake the suspicion that would fall upon you.

Reason number two: side effects like increase in blood pressure. Bitter Orange is the new ephedra or speed-like diet pill. People on ephedra have also had strokes and that is one reason why it was taken off the market. So far there have been no serious problems with bitter orange. But monitor yourself for side effects and get off asap if you develop any side effects.

The diet pills I think are the safest are ginger, green tea, calcium, arginine and glucomanan. They are so safe that the more you take them, the healthier you get.

Let’s start with Ginger. It curbs that unpleasant sensation in your stomach that makes you want to eat. It can help you to go longer between meals.  Instead of having to eat every 2 hours, you can extend it to every 3 or 4 hours. I keep a bottle of ginger capsules in my purse and when I can’t stop working to eat, I take a ginger cap and then I’m good to go for another hour or two. It buys me time until my next meal.

Here’s another unlikely diet pill: arginine. It inceases growth hormone release from the pituitary, and over time it decreases body fat and increases muscle mass. We use IV arginine in the hospital in slow growing children to diagnose them with dwarfism. Arginine causes a release of growth hormone into the bloodstream and after the arginine infusion we measure the blood levels of growth hormone. If they have no growth hormone release then they are diagnosed with drawfism.

There is even a study of it being used to increase the stature of little boys, and it worked.  The deal breaker for most people who want to take arginine is it can cause severe and frequent out breaks of herpes zosters, shingles, genital herpes, cold sores, fever blisters…stuff like that. So maybe that’s why it’s not as popular as it could be. I take arginine and I love it! I think I’ll write a blog about it because it is soOoOoO fabulous.

Then there is glucomanan which is a super fiber that fills you up and stabilizes you blood sugar so it’s not going up and down like a rollercoaster. Actually, any fiber supplement can help you lose weight especially if you take it before meals with a full glass of water.

In the next blog I will talk about diet pills that your doctor can prescribe. I will mention pills you can live on and pills that your insurance will pay for. Stay tuned. But before I go, I just want to say it’s not so bad being a little bit chubby. I think your face looks plumper and younger with a little bit extra weight on, and there is a study that says the death rate of people who are little bit chubby is lower than those who are the perfect weight. The people with the highest death rate were underweight and obese people. Stay tuned for another blog about this study.  Also, if you dress properly you can look fabulous despite being chubby.

Below is a chart on diet pill that can be purchased with a prescription. If you want to find the best quality product look on this website because many products are really not what they say they are and this site actually tests them.




Stimulants Increase Satiety Modulate Carbohydrate Metabolism Modulate Fat Synthesis or    Oxidation Slow or Block
Bitter orange Guar gum Chromium l-carnitine Chitosan Calcium
Caffeine Glucomannan Ginseng Garcinia (hydroxycitric acid; HCA) White bean Green coffee extract
Fastin (brand) Lipozene (brand) Green tea extract  Arginine
Guarana Blond psyllium Conjugated linoleic acid  Ginger
Yerba mate Pyruvate
Raspberry ketone

imagesTestosterone and New Link to Cardiovascular Risks:

If there is one thing I have learned in my 20 years as a pharmacists it is that all drugs are both good and bad. That is proving true with Testosterone.  It’s good because it keeps men vigorous and strong, but the downside it can possibly increase risk of prostate problems, sleep apnea problem and now…cardiovascular disease.   Those seem to be problems predominant in men.  Geez, we already know it’s hazardous being a man.  They don’t even live as long as women.

This a new study linking testosterone use with an increased risk of dying of cardiovascular events. is consistent with and earlier study,

In this new study, 8,709 men who visited a Veteran’s Administration facility for coronary angiography from 2005 to 2011 and subsequently had serum testosterone < 300 ng/dL (< 10.4 nmol/L), were followed for mean 27.5 months. At the time of angiography, 20% had a previous myocardial infarction (MI), 50% had diabetes. More than 80% had at least 20% stenosis in ≥ 1 epicardial vessel on angiography. Following angiography, 14% began testosterone therapy at some point during the follow-up period (63.3% had testosterone patch, 35.7% had injection, and 1.1% had gel). The median time from angiography to beginning of therapy was 531 days. The primary outcome was a composite of all-cause mortality, MI and ischemic stroke.

Before your eyes glaze over with technical terms, I’ll parapharase: men that were studied were already old and falling apart.  They had bad arteries and had undergone a procedure to open the blood vessels in their heart.  Of those men…some were put on testosterone and some weren’t. This study was looking back on data already collected for other reasons. It was not pre-thought out and the men were not divided up equally and fairly. I’m not sure what prompted the men to start on testosterone, but the study did say that those using testosterone were generally younger and healtheir. And that is what is so startling about this study, despite being in better shape they had more heart attacks, strokes and as a results deaths.  It happened 25.7% of the time to the testosterone group, compared to 19.9% for the men not taking testosterone.

Sad, I know. I was hoping testosterone could breathe new life into older more frail men.  I need to re-think that.

So what does that mean for young healthy men?  Does it mean they need to avoid testosterone or start taking it early before they get old and develop clogged arteries? Your guess is as good as mine.

So what should we do differently?  Number one, do everything in our power to reduce cardiovascular risks and do not minimize the importance of this just because we can’t see it developing. We can see skin rashes, skin sores, infections, and sunburns and we can halt the disease with immediate attention.  But this is not the cases with the inner lining of the blood vessels.

Cardiovascular disease is silent and unseen, yet it is deadly.  If we could only look in our bodies and see the inner lining of our blood vessels that carry vital life sustaining blood, oxygen, and nutrients becoming red, inflamed, hardening, scaring, tearing, thinning, scabbing over with plaque, and breaking we would be compelled to take sudden and aggressive action.

In light of this news we need to rethink whether or not to use testosterone in each individual situations.  We need to answer the questions, Would you rather live 20 more years in your current state: testosterone free and for some that includes feeling lethargic, depressed, weak. Or would you rather live 15 years feeling more alive and vibrant and strong.

I’m not “for” or “against” anything. I just feel that people need the facts so they can make up their own minds on how to live their lives.

It’s your life. It was given to you, no one else.

Stay tuned for a future blog on how to assess your cardiovascular risk using an online calculator and how to reduce your risk to as low as possible. Because if you do choose to stay on testosterone, or start it new, I recommend you do everything in your power to take care of your arteries and veins and you can do that with drugs and supplements.  I will tell you how in a future blog.


1/31/2014 What the FDA says about the subject

And, another one of my favorite sources of info:

great hair great hair2

Drugs that reverse hair loss and drugs that cause hair loss.

I don’t have to tell you that your hair is a big part of your appearance and hair can be a tell-tell sign of age. As we age it can become thin, frizzy, brittle and gray.
This is a particularly important subject for me because I had beautiful hair as a teenage and as I got older it got so damaged and unattractive. But the good news, I have completely restored it to my youthful state with one drug listed below. I will reveal that drug in time.
But let me just say that I don’t think baldness is necessarily a bad thing in men. Some women find it very attractive, but I’m sure it can be devistating for some, especially women. This blog is written for those people.

There are several different causes of hair loss but the two most common causes are hormonal related and autoimmune related where the body attacks the hair follicles and kill it. Baldness is seen in both women and men and the drugs used are the same, even though most work best in men who are <40 years of age in the beginning stages of baldness.

Finasteride: also known as Propecia is a pill available on prescription.
Most people don’t realize that there is a pill to treat baldness. But there is and it is used in hormone-related baldness. Originally it was used to treat prostate problems, but they found out it improved baldness. It is used mainly in men but sometimes it is used in women with variable results. In men, finasteride generally works better than drugs applied to the scalp. Loss of libido is a side effect and treatment is usually well tolerated.

It is not clear with women who is likely to respond to therapy. Optimal dosing in women is unknown; higher doses than in men may be necessary. Noticeable results may take six months or longer, and like men, effects are not sustained without continued treatment. Women of child-bearing age should not use finasteride, or must use effective contraception during treatment.

Minoxidil also known as Rogaine is an alternative therapy for patients who can not take the pills. This drug was originally a blood pressure med and is now used in a solution or foam on the scalp. It comes in 2 percent and 5 percent. Five percent solutions works the best, 2 percent solution is usually used by people who get irritation from the 5 percent.

The response to treatment with both agents is variable. People treated with finasteride or minoxidil must continue treatment to maintain efficacy. If treatment is discontinued, hair loss will occur within several months after the cessation of therapy. Scalp irritation is the most common adverse effect of minoxidil. Continuing treatment with minoxidil or finasteride after hair transplantation may help to minimize additional loss of preexisting terminal hairs.

Tretinoin, also known as retin a, is used to increase the absorption of Minoxidil into the scalp.

Biotin 5mg (sometimes expressed as 5,000 micrograms) every day is used by women to grow their scalp hair longer. The testimonials are amazing and it has been studied in a genetic medical condition called tangeled or uncombable hair syndrome in children and baldness in children with variable results. This is the drug that restored my hair. It is once again long, shiny, healthy, strong and straight.

Antharalin cream was tested in men with resistant baldness and did not yield good results.
Spironolactone occasionally used in the treatment of hormonal baldness in women.
Dermatologis specializing in hair restoration also use injections of various chemicals into the scalp.

Combinations are better than single agents alone. There is one reported case of a man using topical 3 percent Minoxidil in 0.01 percent Tretinoin plus oral Finasteride. He was 32-year-old male with androgenic alopecia of 10 year’s duration. Each application was 1 mL; dose of Finasteride was not mentioned. Hair regrowth was noted within the first 3 months. Complete cosmetic goals were reached in 8 months, at which time Finasteride was discontinued, but topical treatment continued.

Rogain $16.32 – $27.36 for a one month’s supply
Finasteride Oral 1 mg (30): $81.38, 5 mg (30): $93.80

It’s also important to know that certain medications can cause hair loss. The most common offenders are:
• Antibiotics and antifungal drugs
• Antidepressants
• Birth Control pills (even though sometimes they are used to treat hair loss)
• Anticlotting drugs
• Cholesterol-lowering drugs
• Drugs that suppress the immune system
• Drugs that treat breast cancer
• Epilepsy drugs (anticonvulsants)
• High blood pressure medications (anti-hypertensives), such as beta-blockers, ACE inhibitors, and diuretics
• Hormone replacement therapy
• Mood stabilizers
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Parkinson’s drugs
• Steroids
• Thyroid medications
• Weight loss drugs
Some of these drugs are life sustaining and should never be discontinued without a doctors approval.


Skin Whitening

October 10, 2013 — Leave a comment

imagesCA0QXOSJSkin whitening, skin lightening and skin bleaching

Skin that is a consistent color is definitely more harmonious, but is lighter always better? Anyone using a skin whitener over a long period of time runs the risk of pigmentation increasing to the joints of the fingers, toes, buttocks and ears. The skin of the face can become thinned and the area around the eyes can have increased pigmentation causing a “bleach panda effect.”

One of the most common skin lighteners is Hydroquinone. It comes in 2 percent (available in cosmetics) to 4 percent (or more) concentrations (available r by prescription), alone or in combination with tretinoin 0.05 percent to 0.1 percent. Hydroquinone also known as Eldoquin, Epiquin Micro, Lustra, Melanex requires a prescription.

How much do they cost? Starting costs for hydroquinone alone is prescription strength 4 percent (28.4 g): $44.00, nonprescription strength 2 percent (28.35 g): $28.90
Hydroquinone does not bleach the skin but lightens it, and can only disrupt the synthesis and production of melanin hyperpigmentation. It has been banned in some countries (e.g. France) because of fears of a cancer risk.
How well does it work? Hydroquinone – 2 percent to 4 percent. The highest concentration is most effective, but may be associated with more severe irritant contact dermatitis, hypopigmentation of surrounding skin, and, rarely, a bluish-black discoloration .

Because of hydroquinone’s action on the skin, it can be irritant, particularly in higher concentrations of 4 percent or greater and predictably when combined with tretinoin. Some medications have been created that combine 4 percent hydroquinone with tretinoin and a form of cortisone. The cortisone is included as an anti-inflammatory. The negative side effect of repeated application of cortisone is countered by the positive effect of the tretinoin so that it does not cause thinning of skin and damage to collagen.

In addition to being an anti-wrinkle cream, tretinoin also lightens the skin. But research has shown that the use of Tretinoin (also known as all-trans retinoic acid) can only be somewhat effective in treating skin discolorations.

Azelaic acid: requires a prescription. is naturally occurring component of grains, such as wheat, rye, and barley. Azelaic acid is used to treat acne, but it is also effective for skin discolorations.

How well does it work? In randomized trials, azelaic acid 20 percent cream or 15 percent gel was found to be more effective than hydroquinone 2 percent and equally effective as hydroquinone 4 percent. Common adverse effects of azelaic acid include erythema, burning, scaling, and pruritus.
Cream (Azelex External) 20 percent (30 g): $274.56, Gel (Finacea External), 15 percent (50 g): $232.18.

Some alternative lighteners are natural sources of hydroquinone. They are safer but more expensive. They include Mitracarpus scaber extract, Uva ursi (bearberry) extract, Morus bombycis (mulberry), Morus alba (white mulberry), and Broussonetia papyrifera (paper mulberry). All of these contain arbutin (technically known anhydroquinone-beta-D-glucoside). Pure forms of arbutin are considered more potent for affecting skin lightening (alpha-arbutin, beta-arbutin, and deoxy-arbutin). Beta-Arbutin is also known by its more common name of Bearberry extract. Arbutin is derived from the leaves of bearberry, cranberry, mulberry or blueberry shrubs, and also is present in most types of pears.

Kojic acid also naturally occurring and does not require a prescription. It is a by-product in the fermentation process of malting rice for use in the manufacturing of sake, the Japanese rice wine. Many cosmetic companies use kojic dipalmitate as an alternative to kojic acid because it is more stable in formulations. In addition to local irritation, kojic acid may cause allergic contact dermatitis.

Monobenzone and mequinol are depigmenting agents. They do not require a prescription unless they are combined with treninoin or hydroquinone.
Depigmenting agents can permanently destroy the melanocytes that produce skin color. It’s a chemical form of vitiligo, the condition that Micheal Jackson claimed to have had.
These agents work best where there are specific zones of abnormally high pigmentation such as moles and birthmarks. Conversely, in cases of vitiligo, unaffected skin may be lightened to match the affected skin and therefore achieve a more uniform appearance.

Other options are Cinnamomum subavenium is a Chinese herb, Niacinamide, licorice extract (specifically glabridin), pomegranate extract, ellagic acid, vitamin E, and ferulic acid.

Beware of skin-whitening products that use any form of mercury which can be harmful.