I have used Hydroquinone 4% with Tretinoin 0.025% for Melasma but I am facing side effects should I keep using it or?

Question

I have been prescribed by my dermatologist a week ago to use Hydroquinone 4% with 0.025% Tretinoin for my Melasma problem, but after using the combination my skin turned red, bit swelled, very dry even some of my skin peeled off with burning effect.When I spotted my skin turned black I have stopped the treatment.Is it normal to have these effects. My Dermatologist in out of country right now what should I do?

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Michele S. Green, MD · Answer

There are some patients who have the opposite effects from these creams and are unable to tolerate them.  You should discontinue these creams for now and possibly use a hydrocortisone cream twice a day to help ameliorate the condition.  Please consult an expert in Melasma to help treat your condition. Best, Dr. Green

Abdulla Fakhro, MD, FACS · Answer

Hello Mj Shaikh, it is not uncommon to have these side effects from your regimen. How are you using the combination? Normally whenever we recommend the combination of hydroquinone and tretinoin creams we urge patients to alternate them at night. It is best if you apply the hydroquinone only on the melasma and then wash your hands, apply tretinoin cream all over your face.  if you are not having issues then you can increase treatment at night and also begin to use hydroquinone in the AM. 
Here's where it gets a bit challenging, you need to observe diligent sun care, something with an spf of at least 50 or so. Using many of the cleanser on the markets to wash your face at night (make sure you dont try new products that you could be sensitive to) 
In the past, I have noticed that some dermatologists will often prescribe some topical steroids when patients have a lot redness. When your doctor returns, ask him or her for advice regarding this. 
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.

John Tanqueray, MBBCh · Answer

Side-effects of redness, dryness, flaking and sometimes soreness and cracking will occur and are to be expected on a regime like this. Melasma is a difficult condition to treat and usually requires more aggressive regime like this. It will not harm your skin to continue, but if you are experiencing any cracking of the skin it is best to back off. You will get better results and more rapid improvement if you can persevere. The side-effects will usually subside after about 6 weeks of use. If you have an important event in the meantime you can reduce or stop applying the creams for a few days and things will settle.Good luck.

David E. Berman, MD (retired) · Answer

If you have skin types 1-4, you should consider the Picosure laser. You should plan at least 3 treatments, spaced a month apart. I would not start these treatments until you rest your skin and the irritation and inflammation resolve. You may also benefit from pre-treatment with HQ. The Picosure laser has little to no downtime since it fires 1,000 faster than other lasers.david berman md

I have used Hydroquinone 4% with Tretinoin 0.025% for Melasma but I am facing side effects should I keep using it or?

Answers (6)

Answer: Side-effects with hydroquinone and tretinoin

Answer: Side-effects with hydroquinone and tretinoin

Answer: I would let everything settle down and then consider using the Picosure laser

Answer: I would let everything settle down and then consider using the Picosure laser

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I have used Hydroquinone 4% with Tretinoin 0.025% for Melasma but I am facing side effects should I keep using it or?

Answers (6)

Answer: Side-effects with hydroquinone and tretinoin

Answer: Side-effects with hydroquinone and tretinoin

Answer: I would let everything settle down and then consider using the Picosure laser

Answer: I would let everything settle down and then consider using the Picosure laser

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Recommended reading

Everything you need to know about Laser Resurfacing

Our mission is to create a world where every investment in modern beauty is Worth It.