Tretinoin and Hydroquinone Safety

Question

How many percent of Tretinoin and Hydroquinone is safe for facial skin? Are there any harmful side effects for these chemicals? I am thinking about using them for melasma treatment.

Raffy Karamanoukian, MD, FACS · Answer

If you are concerned about Hydroquinone, there are non hydroquinone options such as Melarase AM that does not contain HQ. In our office, we recommend Melarase AM and Melarase PM for melasma improvement. Raffy Karamanoukian MD FACS

Anil R. Shah, MD · Answer

Hydroquinone and tretinoin are both relatively safe products.  The main concern with long term use of hydroquinone is in laboratory animals the product promoted tumor development.  In humans, this has not been proven.  Another concern with hydroquinone is the potential to cause onchronosis which is a darkening of the skin and typically occurs with higher concentration of hydroquinone.  Finally, hydroquinone can be drying to the skin and causing untoward textural changes to the skin.  For these reasons listed, my office does not recommend the use of hydroquinone for more than 4-6 months consecutively.  Tretinoin should not be used in pregnancy as this can potentially cause birth defects.  Hydroquinone also is not safe during pregnancy.

Hratch Karamanoukian, MD, FACS · Answer

Hydroquinone is safe when used properly and with a regimen of triretinoin and effective sunscreen. Kare Skin makes it easy by providing a system that includes all of the above. It is the All-You-Need Skin Brightening Kit. See the link below. Hydroquinone is very commonly used in everyday practice by skin specialists.

Michele S. Green, MD · Answer

I would definitely recommend that you use Retinoids and Hydroquinones for Melasma as they are safe and effective. Combining these creams with chemical peels is an extremely effectively way to reduce the melasma and have clear skin.  Strict sun avoidance is necessary to avoid the recurrence of melasma.  Please consult a board certified dermatologist who is an expert in Melasma for the best cosmetic results.  Best, Dr. Green

Don Mehrabi, MD · Answer

Thank you for your question.

	There recently had been a lot of buzz regarding the safety of hydroquinone and its potential carcinogenic risk, however, this potential association has not materialized or been proven, and has not stopped physicians from using this bleaching chemical. It is safe, and nearly all dermatologists use it. You can get hydroquinone in the standard 4% cream from your pharmacy via prescription, or even have it compounded into an 8-10% cream. Just be careful not to overdo the bleaching effect with the higher strengths.

	Tretinoin is safe and comes in maximum strength of 0.1%. It is a standard treatment in anti-aging regimens and is used in a variety of melasma treatments.

	The best choice for melasma is Triluma. This is a prescription consisting of hydroquinone, fluocinolone, and tretinoin. In my experience, Triluma reduces melasma much better than any laser, peel, or other cosmetic treatment. It also surpasses using hydroquinone alone, and hydroquinone-tretinoin combinations.

	Discuss these options with your dermatologist, and good luck treating your melasma!

Bryan K. Chen, MD · Answer

Tretinoin cream increases sun sensitivity so if you are going to use it, you need to be consistent about daily applications of a broad spectrum sunscreen. For someone who has never used hydroquinone before, I would start with 0.025% or 0.05%. Mix a pea-sized amount of medication with moisturizer and apply as you would a lotion to the entire face. Diluting the medication in this way will reduce your chance of developing redness and inflammation that might then create more brown pigmentation. Tretinoin cream should not be used during pregnancy.

	Hydroquinone in combination with tretinoin cream can be effective for the treatment of melasma. Hydroquinone can also cause dryness and irritation and can also be used in combination with moisturizer to reduce these effects. I would use no more than 4% hydroquinone. A higher percentage would increase the risk of a condition called exogenous ochronosis in which a permanent blue-black pigmentation can occur. Even 4% hydroquinone can, in theory cause this problem, but less likely (I have never seen a case of exogenous ochronosis with 4% hydroquinone). In laboratory rats treated with hydroquinone, there is an increased risk of tumor development but it is not proven to be carcinogenic in humans. Hydroquinone should be avoided during pregnancy.

	Overall, I am convinced of the safety of these medications for myself and my patients. I hope this answers your questions.

	Good luck.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher.

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia. Real Self Advisory Board

Tretinoin and Hydroquinone Safety

Answers (7)

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