Hydroquinone and tretinoin for melasma and hyperpigmentation

Table of Content:
Can I use tretinoin and hydroquinone at the same time? | What are tretinoin and hydroquinone used for? | What results can I expect? | Can I use them long term? | How to get them? | How to use them together? | Side-effects | Brands

The combination of tretinoin and hydroquinone cream is considered one of the best treatments for hyperpigmentation and melasma. It is also effective for post-inflammatory hyperpigmentation from acne, eczema, and psoriasis. This article explains the benefits and mechanisms of action of this potent combination and helps you get a prescription for a customized formulation for hydroquinone and tretinoin for your skin. 

Hydroquinone is a skin-brightening component frequently employed to address issues hyperpigmentation such as melasma, freckles, age spots, and other skin pigment irregularities. These can arise from various causes like sun exposure, inflammation, or skin trauma, including those associated with acne vulgaris¹.

Tretinoin, commonly sold under the brand names Retin-A or Altreno, is a commonly prescribed retinoid. It plays a crucial role in regulating skin cell growth and transformation, making it a preferred choice for numerous skin conditions. In essence, tretinoin manages the growth and turnover of skin cells, tackling various skin issues. For example, it accelerates the removal of older skin cells and encourages the generation of fresh ones. Consequently, it helps unblock pores, reduce inflammation, and improve the overall skin texture².

Can I use hydroquinone and tretinoin at the same time?

Dr. Alpana Mohta, expert dermatologist, says that you can use hydroquinone and tretinoin simultaneously under a dermatologist’s careful supervision. In fact, she often prescribes it as a combined solution for melasma and hyperpigmentation.

How to get a prescription for tretinoin and hydroquinone?

To get a prescription for tretinoin and hydroquinone you need to have a consultation with a dermatologist via Miiskin. Consultation price is $59 and med refills are only $39. If this prescription is adequate and safe for you, you will get it in 1-2 business days.

Hydroquinone and tretinoin uses

Hydroquinone and tretinoin are both potent skin agents with distinct properties. This combined formulation can be used for the following:

Melasma 

This combination is frequently used to treat melasma, which presents as brown to gray-brown patches, primarily on the face. Hydroquinone works by reducing the production and increasing the degradation of melanin pigments in the skin. In contrast, tretinoin promotes skin cell turnover, helping to remove the layers with excessive pigmentation^3 4 .

Acne scarring and post-Inflammatory hyperpigmentation

Since hydroquinone and tretinoin are used  to treat post-inflammatory hyperpigmentation from acne scars, therefore this combination is very effective at lightening these spots and promote faster healing^5 6 .

Photoaging

Long-term sun exposure can lead to signs of aging and discoloration known as photoaging. The combined effects of hydroquinone to lighten sunspots and tretinoin to promote skin renewal help address these issues^7 8 .

Prevention of new dark spots

Although hydroquinone is not used as a preventive agent for the new formation of dark spots, tretinoin is. As it boosts cell turnover, the likelihood of pores getting clogged and leading to acne lesions that can cause hyperpigmentation is reduced⁹.

What results can I expect from using a hydroquinone and tretinoin gel?

Lightening of dark spots

Hydroquinone and tretinoin are used independently to lighten the skin. When used consistently, together with a sunscreen with a high SPF, you can expect a noticeable reduction in the appearance of age spots, freckles, melasma, and post-inflammatory hyperpigmentation^{10 11}.

Improved skin texture

Tretinoin promotes skin cell turnover. Over time, you might notice a smoother skin texture, reduced appearance of fine lines, and smaller pores¹².

More even skin tone

With the combined action of hydroquinone lightening dark spots and tretinoin promoting even skin regeneration, users can expect a more uniform skin tone over time.

Reduction in wrinkles

Although hydroquinone doesn’t have any anti-aging properties, tretinoin can decrease wrinkles by having the ability to stimulate collagen production and can lead to a reduction in the appearance of fine lines and wrinkles.

Firmer skin

As tretinoin boosts collagen production, some users may notice their skin becoming firmer and more youthful¹³.

Can I use hydroquinone and tretinoin long term?

Hydroquinone is an active ingredient that can only be used for a short amount of time, typically up to 3 months at a time¹⁴. 

Dr. Mohta suggests that after a few months you switch to using tretinoin and azelaic acid (which is also a skin lightening ingredient) since these two ingredients can be used long term.

How to use tretinoin and hydroquinone together?

Dr. Mohta recommends not using it more frequently, in larger amounts, or for an extended period than prescribed by your doctor. 

You should remember that it might take several weeks to see noticeable improvements in your skin, but using a larger amount of the medicine will not speed up the results.

As a general rule, she says that the combination of tretinoin and hydroquinone gel should be applied once daily during night time since tretinoin is photosensitive. 

You should also use sunscreen with a high SPF every morning (even during winter) while using any retinoids. 

Tretinoin can be quite irritating on the skin if not used properly. So, please read our dermatologist guide on “How to use tretinoin” to minimize skin irritation.

If you’re wondering whether hydroquinone is available over the counter, check out our detailed guide on “Is Hydroquinone OTC?” to learn about availability and regulations.

Potential side effects of using hydroquinone and tretinoin together

• Redness and dryness
• Irritation and peeling
• Burning or stinging 
• Itchiness
• Increased sensitivity to sunlight¹⁵
• Allergic contact dermatitis
• Ochronosis (very rarely) which is a blue-black or gray-blue discoloration that may occur when patients use a high concentration of hydroquinone for a long period or on large areas of the body¹⁶.

Hydroquinone and tretinoin brands

Tri-Luma is a popular and widely available brand that combines tretinoin, hydroquinone, and fluocinolone acetonide which is very effective for hyperpigmentation. You can also get a customized tretinoin and hydroquinone formulation via Skin Medicinals, which is more affordable.

Can I use tretinoin and hydroquinone together?

Yes, Dr. Mohta says that it is possible to use tretinoin and hydroquinone together, whether it is by having two separate medications or by getting a combined medication. 

How fast does tretinoin fade dark spots?

It may take up to three months of constant use for tretinoin to reduce the appearance of dark spots. You may see results faster if you use tretinoin alongside hydroquinone, azelaic acid, tranexamic acid or kojic acid. Remember to consult a dermatologist when combining different ingredients.

Should I apply hydroquinone or tretinoin first?

According to Dr. Mohta, if you are using two separate medications, you should apply hydroquinone in the evening after applying tretinoin.

The takeaway

Although the combination of tretinoin and hydroquinone offers an effective solution for hyperpigmentation and anti-aging due to their synergistic effects, there are many other ingredients that are effective to treat hyperpigmentation.

For best results, consistency in application and sun protection are essential. Always consult your online dermatologist for tailored advice.

References:
https://www.ncbi.nlm.nih.gov/books/NBK539693/
https://www.ncbi.nlm.nih.gov/books/NBK557478
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807702/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800888/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8776661/
https://pubmed.ncbi.nlm.nih.gov/8217756/
https://www.sciencedirect.com/topics/medicine-and-dentistry/hydroquinone

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