ZO Skin Health® in Charleston and Mt. Pleasant, SC

Here is how to use that table. A claim on a cosmetic label, such as “renews” or “restores,” has not been reviewed by the FDA before sale. That does not make those products useless. A routine you enjoy is a routine you keep. It does mean the strongest evidence sits with a short list of ingredients: sunscreen, retinoids, and, for certain kinds of dark spots, prescription lightening creams.

Hydroquinone after the 2020 law change

Hydroquinone is the ingredient people most often ask about, and the rules changed. Under the federal CARES Act, starting September 23, 2020, over-the-counter skin lightening products without FDA approval had to come off the market.[1] The FDA states that there are no FDA-approved or otherwise legally marketed over-the-counter skin lighteners.[1] So drugstore fade creams with hydroquinone are no longer legal to sell, and hydroquinone in the US now comes by prescription.

There is a second detail that most product pages skip. ZO's Pigment Control Creme lists 4% hydroquinone, carries an “Rx only” label, and is marketed in a category DailyMed calls “unapproved drug other.”[3] In plain terms, it is a prescription product that has not been through FDA approval. The FDA names Tri-Luma, a prescription melasma cream, as the only FDA-approved drug that contains hydroquinone.[1]

Hydroquinone also has real risks. The FDA has received reports of skin rashes, facial swelling, and ochronosis, a lasting discoloration of the skin, from hydroquinone skin lighteners, and it notes that ochronosis may be permanent.[1] The ZO label warns that its formula can raise your chance of sunburn, so it calls for sunscreen, protective clothing, and limited sun while you use it and for a week after.[3] The same label lists sodium metabisulfite, a sulfite that can cause serious allergic-type reactions, including asthma attacks, in some people.[3] Tell us if you have a sulfite allergy or asthma.

Because of these risks, hydroquinone belongs under a clinician's eye, with a clear plan for how long to use it and when to check in. It also helps to know which kind of dark spot you have first, since melasma, sun spots, and post-acne marks do not respond the same way. Our hyperpigmentation page goes deeper on those differences.

Using a fade cream and not sure what is in it? Bring the tube to your visit, or call 843-981-0870 first. We will read the label with you, look at the spots it is meant to treat, and say plainly whether it belongs in your routine.

Retinol, retinoids, and the first few weeks

Retinoids are vitamin A ingredients, and they are among the few skin care ingredients with solid evidence for aging skin. The American Academy of Dermatology (AAD) explains that prescription retinoids include tretinoin, tazarotene, and trifarotene, while retinol is a retinoid sold over the counter.[5] Tretinoin is the retinoid studied more than any other for skin aging.[6] Retinol has to be converted in the skin to work, and one review reports it as about 20 times less potent than tretinoin.[6] That is why retinol tends to be gentler, and also why its effects tend to be smaller.

The ZO line uses retinol, not prescription tretinoin. If your goals call for a prescription retinoid, that is a separate conversation about a separate product, and we will have it with you.

Expect an adjustment period. The most common side effect of topical retinoids is a “retinoid reaction” of itching, burning, redness, and peeling, and it usually shows up in the first few weeks.[6] AAD dermatologists suggest starting with a gentle formula every other night and building up slowly, using it at night, and wearing sun protection every day.[5] In darker skin tones, irritation can leave dark marks behind, so going slowly matters even more.[5]

Two hard stops. The AAD says retinoids should not be used during pregnancy.[5] And if your skin is already very red or inflamed, retinoids are usually not the place to start.[5] Tell us if you are pregnant, planning a pregnancy, or breastfeeding, and we will build a routine that leaves these products out.

How we build your ZO routine, and what to expect by week six

Your first visit starts with your skin and your goals, not a product list. We look at your skin type, what you already use, what has irritated you before, your sun habits, and any medicines or pregnancy plans that change what is safe. Then we pick the fewest products that cover the job, usually a cleanser, a treatment step, a moisturizer if you need one, and sunscreen.

Sunscreen is the step we will not drop. The AAD recommends a broad-spectrum, water-resistant sunscreen with SPF 30 or higher, reapplied about every two hours, or after swimming or sweating.[7] It notes that sunscreen helps prevent early skin aging, such as wrinkles and age spots, caused by too much unprotected UV.[7] Every other step works better when this one is in place, and ZO's sunscreens are regulated as over-the-counter drugs, the same as any other sunscreen.[2][7]

Results take patience. Most people notice small changes in the first weeks and clearer improvement over about six weeks, and pigment and texture goals often take longer. When something stings or flares, we adjust the routine instead of asking you to push through. Once your routine is set, you can restock at a visit or through our online ZO store.

Visits are with Ashley Harwyn, PA-C, who is board certified in anti-aging and functional medicine (A4M) and holds the ABAAHP credential. You can see her at our office at 496 Bramson Ct, Ste 120, in Mount Pleasant, or downtown at The Longevity Club, 163 Rutledge Ave, Ste 202. Solcara posted the short video below to its YouTube channel in February 2023. If anything in it differs from this page, the written guidance and references here are the current version.