How to use tretinoin and hydroquinone

How to use separate tubes

Confirm the application order and frequency with your prescriber before starting both products. Write the application order down, because a bathroom shelf is not a filing system.2

1Test hydroquinone on an area about 1 cm across. Wait 24 hours before wider use; do not proceed if redness or irritation develops.
2Wash your hands and treatment area with a mild cleanser. Let the skin dry as directed for your tretinoin product.
3Apply hydroquinone as a thin film only to the darker areas. General starting guidance is once daily, increasing to twice daily after one week without irritation, unless your prescription says otherwise.
4Apply tretinoin at bedtime in a thin layer over the prescribed treatment area. Keep it away from eyes, mouth, ears and nose corners, and do not apply to sunburned skin or eczema.
5For a morning hydroquinone application, wait 10 minutes before sunscreen or cosmetics. Use moisturizer for dryness as directed.

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How to use Tri Luma

Tri Luma contains hydroquinone 4%, tretinoin 0.05% and the corticosteroid fluocinolone acetonide 0.01%. It is for short term treatment of moderate to severe facial melasma, a condition that causes darker patches. After gentle cleansing and drying, apply a thin film once daily, at least 30 minutes before bedtime. Cover the melasma patches and about half an inch of surrounding skin, rubbing lightly. Stop when control is achieved; Tri Luma is not a maintenance treatment.4 5

What goes on during the day?

Use broad spectrum sunscreen with SPF 30 or higher, seek shade and wear a wide brimmed hat. Sunlight increases pigment and can worsen melasma. A tinted sunscreen containing iron oxide is an option dermatologists recommend for melasma. When wearing camouflage makeup, apply any daytime melasma medication first, then sunscreen, then makeup. Makeup belongs after sunscreen, even if the foundation's name sounds like it should be in charge.6

How long should you use them?

Review hydroquinone treatment at three months and stop if there has been no benefit. Some patients use hydroquinone twice weekly afterward to maintain improvement; agree that plan with your prescriber rather than extending daily use indefinitely. Melasma treatment as a whole usually takes 3 to 12 months to show results. Melasma can return after stopping Tri Luma, so ask about a different maintenance treatment.3 4 6

What should you avoid or stop for?

Avoid abrasive cleansers, drying alcohol products and additional topical medicines such as benzoyl peroxide or salicylic acid unless your doctor directs their use. Irritating skincare can worsen melasma. Dryness, peeling and mild burning can occur, but stop hydroquinone for excessive redness, scaling, itching or weeping. Stop and contact your clinician for gradual blue black darkening, called ochronosis. Call promptly for pain, hives or a rash; seek urgent care for breathing difficulty or a severe allergic reaction.2 3 4 7

Discuss pregnancy, pregnancy plans or breastfeeding before using either medicine. Hydroquinone's safety during pregnancy and breastfeeding is not established, and tretinoin carries pregnancy risks. Tell your prescriber about eczema, allergies and other medicines. In the US, hydroquinone skin lightening products are not legally sold over the counter.2 3 4 5

How does tretinoin cream compare with hydroquinone?

Difference	Tretinoin	Hydroquinone
Main action	Increases new skin cell production and unclogs pores; also helps pigmentation	Reduces production of melanin, the pigment that colors skin
Other uses	Acne and fine wrinkles	Dark marks after inflammation, including acne
Usual application	At bedtime, as prescribed	Only on darker areas, at the prescribed frequency
Role together	Can enhance hydroquinone's effect	Targets excess pigment