HQ+ - Apply once or twice a day depending on pigmentation problem. For small amount of pigmentation, use once in the evening. For heavy pigmentation, use once in the morning and once in the evening. Apply an even amount (approximately dime size) to freshly washed skin. Leave on skin. Important: Follow with a 30 SPF sunscreen. HQ+ AHA contains an additional 4% glycolic acid. This may make it slightly irritating to the skin; however the skin-lightening agent will penetrate quicker due to the exfoliation. You will need to diagnose which patients will benefit from which HQ+ product (HQ+AHA and HQ+Bearberry.) To accelerate results, a tretinoin such as Retin-A or Renova, may be prescribed with HQ+. Patients will apply the Retin-A or Renova after the HQ+ Hydroquinone product in the evening. This program will take approximately one to two skin cycles to achieve results (30-60 days.) It is recommended that patients stay on a daily regimen for 8 weeks total, then assume a maintenance schedule where HQ+ is used twice a week, indefinitely. The continuation of tretinoin usage with HQ+ is at the physician’s discretion. Patients exposed to the sun will experience a recurrence of pigmentation. While patients will experience quicker results with a combination of tretinoin & HQ+, this treatment often causes a two-week period where the skin will be irritated as it builds up a tolerance to products. If patient skin becomes excessively irritated, reduce tretinoin usage to twice a week. Remain using HQ+ everyday.