Even Out!

Instructions

You have stated that you wish to take a topical medication to lighten dark spots. Hydroquinone 5%, Vitamin C 1%, Niacinamide 4% cream is applied in a thin layer to affected areas. Avoid applying directly to genitals. Begin at bedtime for 2 weeks and if tolerating well can increase to morning and night. You may apply to just problem areas if they are small isolated spots, or more diffusely if the areas are more widespread. You will cycle on for a maximum of 4 months use of hydroquinone followed by at least a 2 month break to cycle off. This is to avoid chronic continuous use which can result in a rare side effect called ochronosis where the medication can stimulate new pigment production.

Refill

You will need to place a new one-time order. Hydroquinone is not available on a subscription plan. We advise the stop of treatment if there is no improvement or concerning symptoms.

If your symptoms aren't getting better after you start taking the medicine or if you develop new or worsening symptoms such as fever, chills, nausea, vomiting, or pain, you should see a doctor in-person and call or message us immediately. Furthermore, if your symptoms are not simply dark spots, then an in-person exam with a physician is necessary to determine a correct diagnosis.

Allergies

This medicine may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following, please stop taking the medicine and message your wisp doctor, or seek an in-person:

• Hydroquinone
• Niacinamide
• Vitamin C
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop or discover that one of these conditions applies to you please stop taking this medicine and call or message us immediately:

• Pregnancy
• Breastfeeding
  
  

Pregnancy and Breastfeeding

This is not recommended for use during pregnancy or breastfeeding due to the potential for side effects in the infant.

Medicines, Supplements, and Foods

We have evaluated your health history and the specific health information you provided us, however if anything changes and you start new medicines, supplements, or skincare treatments not previously reported, call or message us before you take the medicine. Some medications, supplements, or additional skincare treatments can cause severe or dangerous side effects while using with Hydroquinone, Benzoyl Peroxide, Hydrogen Peroxide, & other Peroxide ingredients. Caution using other skin acids to minimize skin irritation.

Emergency Side Effects

This medicine can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in person.

• Severe skin rash, blistering or changes
• Mucosal (eyes, mouth) rash/peeling
• Shortness of breath or wheezing
• Pregnancy
• Becoming pregnant while taking this medication
• Headache
• Nausea
• Vomiting
• Abdominal cramps
• Muscle twitching
  
  

Other Side Effects

This medicine can also cause other side effects including dryness, peeling, itching, burning, and irritation at the application site. Hydroquinone also carries a risk of developing exogenous ochronosis, a blue-black discoloration of the skin. This risk increases with prolonged use of hydroquinone and continued sun-exposure. To avoid this, you'll need to take periodic breaks from hydroquinone. As always, follow the advice of your doctor and wear a daily SPF of at least 30.

Risks

Accurate Information

We have evaluated the specific health information you provided and are making our recommendations based on it. If you forgot to provide or incorrectly provided that information we may misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. If you need to clarify or update any information about your health you can message or call us anytime.

Treatment Failure

This treatment is not 100% effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency call 911 or seek immediate medical help in-person. You may need to seek alternative treatment such as those listed below or in the follow-up plan.

Misdiagnosis or Delayed Diagnosis

There is also a risk that we may incorrectly diagnose or fail to diagnose the correct conditions that you may have, thereby affecting our recommendation for treatment. This risk exists with in-person care as well, but they may have additional clinical history, physical exam findings and tests to aid their evaluation. We use evidence-based practice guidelines and clinical decision making to try to minimize these risks. Here are some other diagnoses (not all inclusive) that we attempt to rule out:

• Other benign causes for brown spots such as seborrheic keratoses.
• Skin cancers - if any lesion concerns you for changing in size, shape or color please see a dermatologist in person for an exam under magnification.

Other conditions that can cause Acanthosis Nigricans:

• Diabetes
• Insulin resistance
• PCOS
• Metabolic syndrome
• Endocrine disorders
• Genetic Syndromes
• Malignancy or cancer -Autoimmune disorders
• Medication induced Acanthosis Nigricans

Accepting or Declining Our Recommendation

We are recommending this treatment for you because the potential benefits of treatment outweigh the risks. You should evaluate this information as well as the manufacturer's pamphlet, and any input from your in-person healthcare team, or other relevant information to decide if this treatment plan is appropriate for you. You are free to decline our treatment recommendations although doing so may prolong symptoms and can be associated with other risks or negative outcomes.

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person doctor, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.