It’s 2019, so all of us skincare junkies know that there are prescription-grade treatments and, well, everything else. (Sorry, but clinical-grade is not a true designation, as nice as some of the products are.) But I digress.

In our quest for better skin, we all know that science will ultimately prove that most prescription ingredients, such as tretinoin, work best. And if they are available over the counter, like Hydroquinone or glycolic acid, we also know that they work best at the concentrations they are only available via prescription.

But it’s hard to get prescription treatments. There’s the six-month average dermatologist visit wait, for one. And then the cost — sometimes insurance covers it, sometimes it doesn’t, so how does someone figure out their skincare budget that way?

Enter hers. For $37-75 per ounce — roughly the same as an over-the-counter treatment — you can now get a prescription-grade treatment, without ever having to leave your house. (!) The secret is that you complete an online medical visit including a selfie at forhers.com, and your results are sent to a board-certified physician, who then evaluates the results and prescribes you one of three treatments for your specific issue:

• Acne
• Melasma
• Anti-aging

I was sent The Melasma Treatment after pregnancy. The Melasma Treatment has prescription-strength tretinoin, kojic acid, hydroquinone, and hydrocortisone. Be sure to keep in mind, though, that tretinoin and other topical retinoids should not be used by women who are breastfeeding.

The active ingredient in Retin-A, tretinoin (brand name Renova), is the only chemical to date to receive FDA approval for anti-aging and anti-sun damage properties. According to research by Fisher et. al cited by Dr. Leslie Baumann in Cosmetic Dermatology, retinoids are effective in preventing and treating the collagen loss caused by photodamage. UV exposure decreases collagen types I and III with 24 hours, but treatment of the skin with all-trans retinoic acid prevents the loss of these types of collagen synthesis. In addition, Fisher et. al demonstrated that application of tretinoin inhibits the induction of matrix metalloproteinase genes (more here), which are in part responsible for collagen degradation.

Kojic acid is normally used twice a day for 1-2 months for the lightening of dark spots or the treatment of melasma. According to a Baumann-cited study by Garcia, kojic acid combined with glycolic acid was more effective than 10% glycolic acid or 4% hydroquinone for the treatment of hyperpigmentation. A third Baumann-cited study by Lim et. al. found that 2% kojic acid in combination with 10% glycolic acid and 2% hydroquinone further improved melasma symptoms over a mixture of 10% glycolic acid and 2% hydroquinone alone.

Since 1982, hydroquinone has been FDA-approved for the treatment of freckles, melasma, and general brown patching. Today, hydroquinone is the most commonly used bleaching agent in the United States. Over time, hydroquinone has acquired a much-deserved high reputation in the dermatology community, as it is considered to be very effective in reducing the appearance of dark spots on the skin. Hydroquinone works by inhibiting the activity of tyrosinase, the rate-limiting enzyme of melanin production, and by increasing the cytotoxicity of melanocytes (melanin-producing cells). However, hydroquinone has been banned in some countries, including France and South Africa, for concerns about increased cancer risk and ochronosis (darkening of the skin) with its use. Recently, the FDA has raised concerns about the use of hydroquinone and other skin-bleaching agents, as they reported that they wish to “establish that over-the-counter (OTC) skin bleaching drug products are not generally recognized as safe and effective.”

The Melasma Treatment definitely made a difference in my age spots. I wish I had taken photos before and after, but the spots do look dramatically lighter. One word of caution is that my skin is a bit sensitive, and the formulation made my skin a bit dry at first, so I started with use every other night, and gradually worked up to daily nighttime use over the course of 2-3 weeks. Forhers.com even provides customers access to a doctor through their platform with whom you can discuss any issues you may be experiencing.

Overall, I’m a huge fan of The Melasma Treatment from hers. I think that it’s genius to send prescription-grade treatments over the internet so you can avoid six-month dermatologist appointments just to get them, and I would highly recommend the service.

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