The short answer
- Evening: cleanse, wait until skin is completely dry, apply hydroquinone to the dark patches (or the whole area as prescribed), then a pea-sized amount of tretinoin for the face. Or use one triple-combination cream.
- Morning: gentle cleanser, moisturiser, broad-spectrum SPF 50, ideally a tinted (iron oxide) sunscreen for melasma.
- Course: usually 8–12 weeks, then reassess; long continuous use of hydroquinone is avoided.
Why combine them?
Hydroquinone blocks tyrosinase, the enzyme that makes melanin, so pigment cells produce less colour. Tretinoin (a prescription retinoid) speeds up skin turnover so pigmented cells are shed faster, and it helps hydroquinone get into the skin. The classic “Kligman formula” combined hydroquinone, tretinoin and a steroid to reduce irritation; the licensed version today is Tri-Luma (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%), approved for 8 weeks of use for moderate to severe facial melasma.
| Option |
Contains |
Notes |
| Triple combination (Tri-Luma; compounded creams) |
Hydroquinone + tretinoin + mild steroid |
Once nightly; short courses because of the steroid |
| Two separate products |
Hydroquinone 2–4% + tretinoin 0.025–0.1% |
More flexible; easier to adjust for irritation |
| Non-hydroquinone alternatives |
Azelaic acid, tranexamic acid, cysteamine, kojic acid, niacinamide |
Used between hydroquinone courses or when it isn’t tolerated |
Hydroquinone is prescription-only in the UK, EU and Australia, and since 2020 it can’t be legally sold over the counter in the US, where the FDA has warned about unapproved skin-lightening products, some containing mercury. Creams sold online combining hydroquinone with a potent steroid such as mometasone or clobetasol can cause steroid damage (thinning, acne, rosacea-like rash) when used for months.
A starter routine
| Weeks |
Evening |
Morning |
| 1–2 |
Hydroquinone nightly; tretinoin 2–3 nights a week, a few minutes after hydroquinone |
Cleanser, moisturiser, SPF 50 |
| 3–4 |
Increase tretinoin to every other night if tolerated |
Same |
| 5–12 |
Both nightly if skin tolerates; moisturiser on top if dry |
Same; reapply sunscreen outdoors |
| After 12 weeks |
Review with the prescriber: taper, maintenance (e.g. azelaic acid), or a break |
Sun protection continues year-round |
- Apply to completely dry skin, 15–20 minutes after washing, to reduce stinging.
- Avoid the corners of the eyes, nostrils and lips.
- Don’t add other irritants (AHAs, scrubs, benzoyl peroxide) at the start.
- Expect improvement after 4–8 weeks; melasma often returns with sun or hormonal triggers.
Safety points
Pregnancy and breastfeeding: avoid tretinoin, and generally avoid hydroquinone. Isotretinoin (Roaccutane): don’t combine with hydroquinone or topical tretinoin unless your dermatologist plans it; skin becomes very sensitive. Ochronosis: long-term, high-concentration hydroquinone can rarely cause a permanent blue-black darkening, more often in darker skin; this is why courses and breaks are used. Stop and seek advice if patches get darker or blue-grey.
More on retinoids, steroid strengths and pigment treatments is in the skin treatments guide.
Frequently asked questions
Should I apply hydroquinone or tretinoin first?
Either order can work. Many dermatologists suggest hydroquinone first on the pigmented areas, then tretinoin, a few minutes apart. Some split them: hydroquinone in the morning (under sunscreen) and tretinoin at night.
Can I use a moisturiser with hydroquinone and tretinoin?
Yes. Apply a plain, fragrance-free moisturiser after the treatments, or before tretinoin as a “buffer” if your skin is irritated.
What does “hydroquinone, tretinoin and mometasone furoate cream” do?
It’s a triple combination with a potent steroid (mometasone), sold in some countries. It can lighten melasma, but because of the steroid it should only be used for short periods under medical supervision.
Can I use tretinoin after microneedling?
Wait until the skin has fully recovered, usually 3–5 days or as your practitioner advises, before restarting tretinoin or hydroquinone.
Sources and further reading
CanforaMedicine Guide
