How Do I Use Hydroquinone 4% and Tretinoin 0.025% to Treat Melasma?

Typically you would wash the face and apply the medications at night prior to retiring to bed. You should be religious about the daily use of sunscreen and avoid sun-exposure. You may experience irritation and redness and for this reason most prescribers advise combining this regimen with a topical steroid.

Thanks for your question.  Both medications are useful for helping with melasma.  You will want to start more slowly with the tretinoin (retin-a) cream, maybe all over the face every other night, or every third night.  The hydroquinone can be combined with the tretinoin, and can also be used every night.  It does not tend to cause much irritation or peeling, but the tretinoin can be a bit tricky as far as dryness.  Use an excellent sunscreen, like the Elta MD products, every day, and we love a gentle cleanser such as ZO gentle cleanser or an Elta Foaming Facial Cleanser which will get the skin ready for product use.

Hello anastasia1965, yes, the two products are largely recommend together by most physicians and skin specialists. The instructions for application are very specific, I ensure my patients know exactly how to go about the routine. Wash your hands, your face with a deep cleanser, then apply the HQ to the dark spots and the tretinoin to the rest of your face.  Tretinoin helps Hydoquinone penetrate better which yields better outcomes. You can also apply a moisturizer over the two when you are done to help moisturize your skin. It is important you adhere to strict sun care and avoid direct sunlight this is because tritenoin will really irritate your skin in the sun.  
This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion.The information provided should not be relied upon as a substitute for consultations with a qualified health professional.

When first starting hydroquinone and tretinoin creams, alternate them at night so your skin slowly become accustomed to them.  Use hydroquinone only on the brown spots and the tretinoin cream all over your face.  If you are tolerating them, increase treatment to every night.  If tolerated, also use the hydroquinone in the morning.  You must use SPF 50+ and avoid the sun.  Neutrogena or any mild cleanser is a good choice for washing your face.

You should consult with a board certified dermatologist who can prescribe more potent fading products for you and determine if you are a candidate for glycolic peels or laser treatments.

Ideally for your melasma you will have a proper assessment and management plan by your dermatologist. The soap is fine and won't affect things either way. I would use the hydroquinone in the morning, with sunscreen overtop and the tretinoin at night time after washing. As well, you can obtain a prescription for a combination cream which includes both ingredients along with other fading ingredients to be used simply at night time - see your dermatologist for this "Kligman formulation."

HQ and tretinoin are excellent treatments for improving discoloration. These two products at bedtime, along with SPF and antioxidants daytime, are the most recommended precription agents for hyperpigmentation. Triluma has both HQ and tretinoin in ONE product, so many doctors recommend this product for excellent results.

Titrate slowly. Start off a few nights a week, diluted if needed and push up from there. 


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.