How long does hydroquinone 10% + kojic acid 4% + tretonin 0.1% + steroid cream takes to work?

Dark pigmentation on the skin can be due to melasma, age spots, and sun damage. Melasma is a specific hormonally-influenced skin condition in which pigmentation is deposited by overactive pigment cells in your skin.

In our office, we individualize treatments for melasma and skin discoloration based on skin type, skin complexion, hormonal influences, and ethnicity.

Treatments for melasma begin with Melarase creams as follows:

MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Additional therapies include fractional laser, fractional RF, Covalent peels, and LED microneedling with Replenish serum. The video demonstrates the clear and brilliant laser that is used alongside Melarase creams.

Best, 

Dr. Karamanoukian

Realself100 Surgeon

It should lighten in 4 weeks and by 8-12 weeks it wil have maxed out. If persistent you could follow up with vi peel which is safe for any color of skin and can decrease melasma even more. 

It can take six to twelve weeks to see the lightening effect.  Stop the cream for a day or two if you are having too much redness or irritation and always use sun protection.

That is a strong combination topical product for the treatment of melasma. I usually see results with lightening creams at the 4 week mark. If you are getting red and dry with application, consider applying a moisturizing cream 1-2 minutes after the application of the lightening cream.

My melasma program last for 10 weeks, so at week one, you should not be having these side effects- possibly the HQ at that concentration is causing irritation. I suggest you speak to your dermatologist about titrating the dose. Melasma 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. 
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
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. 
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia