Cream
Acne Cream
Triple-action topical for acne: antibiotic (clindamycin + erythromycin) and antifungal (ketoconazole). Covers bacterial and fungal acne.
Starting at $101/mo
MelasmaDark spotsHydroquinone 8%
Hydroquinone / Kojic Acid / Hydrocortisone Cream
RxPrescription onlyApplied to the skin · Once a day · Melasma · Dark spots · Hydroquinone 8%
Starting at $94/mo
A strong prescription cream for stubborn dark spots: hydroquinone 8% and kojic acid 4% to slow pigment, with hydrocortisone 0.5% to calm irritation. Applied once a day in a course your physician sets.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Two pigment-slowing actives: hydroquinone 8% and kojic acid 4%
- Hydrocortisone 0.5% reduces the redness and irritation they can cause
- A course with a set length, not a cream for continuous use
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is this cream?
(hydroquinone 8% + kojic acid 4% + hydrocortisone 0.5%)
Hydroquinone and kojic acid both slow tyrosinase, the enzyme that makes melanin, so they work on pigment from the same step with two molecules. Hydroquinone 8% is a high strength, above the 4% of most prescription creams, so irritation is more likely; the mild corticosteroid hydrocortisone is included to calm it. Because it contains a steroid and a high-strength hydroquinone, it is prescribed for a limited course on the dark spots only, not for the whole face or for long-term use.
- How it is taken
- Applied to the skin
- How often
- Once a day
- Form
- Melasma · Dark spots · Hydroquinone 8%
8%
hydroquinone, a high strength reserved for stubborn pigment
Higher strengths have not been shown to work better in everyone and irritate more. Daily SPF 30+ is part of the treatment.
How it works,
week by week.
Week 1
Your physician assesses your pigmentation pattern and recommends the right strength. Start with the gentlest option; escalate if needed.
Week 4–6
Fading usually starts to show. With the combinations, redness and peeling are common in these weeks.
Month 2–3
The triple combination ends its course at about 8 weeks. Hydroquinone alone keeps fading the spots gradually.
After the course
Your physician ends the course and plans the break and the maintenance. SPF 30+ daily, always.
What you may notice,
and when.
Sun protection critical
pigmentation will rebound without SPF 30+
Gradual lightening
results take weeks to months; patience essential
Ochronosis risk
rare, with long continuous use; that is why it is used in courses
Even tone
results continue refining; maintenance is ongoing
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
These creams contain hydroquinone and are prescription treatments. Do not use them if you are pregnant, trying to become pregnant or breastfeeding; the triple combination also contains tretinoin, which must not be used in pregnancy. Two of them contain hydrocortisone, a corticosteroid: used longer than prescribed it can thin the skin. Do not use them if you are allergic to hydroquinone, kojic acid or sulfites, and tell your physician if you have asthma. Apply only to the dark spots, never on broken or irritated skin, and keep away from the eyes and lips. Use a broad-spectrum SPF 30+ every day. Hydroquinone is used in courses with breaks: with long continuous use it can rarely cause ochronosis, a blue-black darkening of the skin. If the treated skin gets darker instead of lighter, stop and contact your physician. A new or changing mole or spot needs an in-person check, not a brightening cream.
The research behind
hydroquinone.
Hydroquinone is a prescription skin lightener used for melasma. Its strongest trial evidence is for triple combinations with a retinoid and a steroid; the cream alone has fewer and older comparisons.
- Triple cream26.1% vs 4.6%
Two 8-week investigator-blind trials in 641 mostly female adults with melasma. At week 8, 26.1% of the triple cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone 0.01%) had complete clearing, against 4.6% in the dual-combination groups combined.
Taylor et al., Cutis 2003;72(1):67-72 - Against kojic acidfaster at week 4
Hydroquinone 4% against kojic acid 0.75% for facial melasma: hydroquinone responded earlier, by week 4, and was superior at the end of 12 weeks.
Monteiro et al., Indian J Dermatol 2013;58(2):157 - Ratingstrong for triple
A systematic review of 35 randomized trials of topical melasma treatments gave strong recommendations to cysteamine, triple combination therapy and tranexamic acid. Hydroquinone alone was not in that top group.
Austin et al., J Drugs Dermatol 2019;18(11)
What the studies found
- Triple cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone 0.01%) gave complete clearing in 26.1% at week 8 vs 4.6% for dual combinations (Taylor et al., Cutis 2003).
- Hydroquinone 4% responded earlier than kojic acid 0.75% and was superior by week 12 in facial melasma (Monteiro et al., Indian J Dermatol 2013).
- A systematic review rated the triple combination as a strong recommendation for melasma (Austin et al., J Drugs Dermatol 2019).
Trial results are for the stated strengths of each ingredient; the triple-cream trial used 4% hydroquinone, while the creams in the catalog are 6% and 8%. Hydroquinone is a prescription drug; these are the pharmacy's versions, and compounded versions were not studied.
What this does not say
- The review notes that triple combination agents carry a theoretical risk of ochronosis, a darkening of the skin with long-term use.
- The triple-cream trial enrolled Fitzpatrick skin types I to IV over eight weeks; longer use was not measured.
- Results of combination creams are not results for hydroquinone alone, and we did not find trials of the 6% and 8% strengths in the catalog.
The research
behind it.
Kojic acid is a tyrosinase inhibitor; small trials found that adding it to hydroquinone improved melasma in some people who had not responded to hydroquinone alone.
Kojic acid is a known cause of contact allergy, and a corticosteroid used on the face for too long can thin the skin and cause visible vessels. Stop and tell your physician about burning, a rash or any darkening.
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I use Hydroquinone / Kojic Acid / Hydrocortisone Cream?
Applied to the skin, once a day, at bedtime. The starting prescription is 1 mL each time. Your physician sets your own dose and it is printed on your label.
What exactly is in it?
Hydroquinone 8%, Kojic Acid 4%, Hydrocortisone 0.5%.
How much arrives in each shipment?
1 tube at the starting strength, shipped to your door from a licensed US pharmacy.
Why does it contain hydrocortisone?
To calm the irritation that high-strength hydroquinone and kojic acid can cause. It is a low-strength steroid, but on the face it should still be used only for the course your physician prescribes.
Why use cycles with hydroquinone?
Long continuous use increases the risk of ochronosis, a blue-black darkening that is hard to reverse. Courses with breaks, set by your physician, keep the benefit and lower that risk. Creams with a corticosteroid or tretinoin have shorter courses.
Can I use brightening creams in summer?
Yes, but SPF protection becomes even more critical. Sun exposure reverses all progress and worsens melasma. Consider higher SPF (50+) and protective clothing in summer.
What if brightening cream makes my skin darker?
Rebound hyperpigmentation can occur if you discontinue hydroquinone abruptly or skip sun protection. Gradual tapering and consistent SPF prevent this. If darkening occurs, contact your physician.
Can I combine brightening cream with other actives?
Space them: hydroquinone or tretinoin at night, vitamin C or other actives in the morning, at least 12 hours apart. Avoid mixing hydroquinone with strong exfoliants until your skin adapts.
Hydroquinone / kojic acid / hydrocortisone educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
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Stronger prescription cream for stubborn melasma and dark spots: hydroquinone 6% with tretinoin, hydrocortisone, kojic acid and vitamins C and E. A short course, usually up to 8 weeks.
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References
- 1.Hydroquinone in melasma: efficacy, safety, and ochronosis risk with long-term use. J Am Acad Dermatol, 2014
- 2.Combination depigmenting therapies in melasma: a systematic review. Dermatol Ther, 2019
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.