Tretinoin and Hydroquinone Safety

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.

Doctor Answers 3

Both Hydroquinone and Tretinoin are safe. You can do Hydroquinone 4-8% and Tretinoin 0.1%.

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!

Beverly Hills Dermatologist
5.0 out of 5 stars 1 review

Tretinoin and Hydroquinone Safety

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.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Non hydroquinone skin lightening with Melarase

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

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 85 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.