Combined melasma formula guide
How to use the prescribed hydroquinone, tretinoin, kojic acid and niacinamide compounded formula on its limited schedule.
Combined melasma formula guide
How to use the prescribed hydroquinone, tretinoin, kojic acid and niacinamide compounded formula on its limited schedule.
- READ TIME
- 3 min read
- PATHWAY
- Compounded melasma formula
- DOSE RANGE
- Two nights a week → Two nights a week
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On this page
How to use
- What it is and how it works
The validated compounded formula contains hydroquinone 4%, tretinoin 0.025%, kojic acid 2% and niacinamide 4% in a pharmacy-defined light gel-cream or emulsion. It targets confirmed melasma through complementary effects on pigment and skin renewal.
- Apply it as prescribed
Apply a thin layer only to the prescribed melasma patches on 2 nights per week. Use on clean, fully dry, intact skin and avoid the eyes, lips, nose folds and mucosa. Wash your hands afterwards and use only the labelled 30 g preparation.
- Skin care and interactions
Apply broad-spectrum SPF 50+ every morning and reapply during exposure. Do not add another hydroquinone, retinoid, acid, scrub, hydrogen peroxide or benzoyl peroxide to the same area unless reviewed. Keep cleansing and moisturising simple and gentle.
First 8 weeks. Take dated photographs in the same daylight at the start, 4 weeks and 8 weeks. Redness and peeling on the mornings after application are expected; persistent inflammation is not, and can itself darken melasma. Tell your doctor. Broad-spectrum SPF 50+ every morning, reapplied outdoors; tretinoin increases sun sensitivity.
Ongoing. Stop immediately and tell your doctor if you become pregnant or plan a pregnancy; tretinoin is contraindicated. Stop and ask for review if the skin darkens, develops blue-black marks or blisters. No waxing, peels or other retinoids or acids during the course. Store the cream as the pharmacy label says.
Treatment pathway
- Two nights a weekWeeks 1-2
- Two nights a weekWeeks 3-8
- Two nights a weekWeeks 9-12
Reviews happen through your account chat; send dated photos in the same daylight each time.
See the full decision pathway
Your melasma formula pathway
Weeks 1-12
Two nights a week on the patches
Thin layer on fully dry skin, washed off in the morning, SPF 50+ every day.
At 8 weeks, are the patches visibly lighter and the skin calm between applications?
Yes
Complete 3 months, then break
Stop after the course; total hydroquinone exposure never exceeds 6 months continuously.
No
Doctor review
If irritation is the problem, the frequency stays at two nights and a moisturiser is added; if response is the problem, the diagnosis and in-person options are reconsidered.
Weeks 1-12After the course
Maintained
SPF and non-hydroquinone care
Daily protection; niacinamide or azelaic acid can be used between courses.
Recurrence
Repeat after a break
A further course only after a hydroquinone-free interval agreed with your doctor.
Reviews happen through your account chat; send dated photos in the same daylight each time.
Dose schedule
| Dose | When | Note |
|---|---|---|
| Two nights a week | Weeks 1-2 | Non-consecutive nights; redness and peeling are expected. |
| Two nights a week | Weeks 3-8 | Do not increase frequency. Photo review at 8 weeks. |
| Two nights a week | Weeks 9-12 | Complete 3 months, then a planned break with SPF only. |
How it compares
| Melasma treatments compared | How it works | Best suited for | How often | Course | Product type |
|---|---|---|---|---|---|
| Hydroquinone 4% cream | Tyrosinase inhibitor; slows new pigment formation | First course; defined patches; drier or sensitive skin | Once daily, then twice daily | 60-90 days | EU-authorised medicine |
| Hydroquinone 4% gel | Same active in an alcohol-glycolic acid base for better penetration | Resistant patches; oilier skin; tolerates a drier vehicle | Once daily, then twice daily | 60-90 days | EU-authorised medicine |
| Compounded melasma formula | Hydroquinone plus tretinoin, kojic acid and niacinamide (Kligman principle) | Patches that have not responded to hydroquinone alone; no pregnancy plans | Two nights a week | 3 months | Pharmacy-compounded to prescription |
All three require daily broad-spectrum SPF 50+ and a planned break after the course. Hydroquinone is not recommended in pregnancy; tretinoin is contraindicated.
Side effects
Local irritation
Mild redness, dryness, stinging or peeling can occur, especially at the start. Use a gentle moisturiser and follow the prescribed adjustment plan. Stop and seek advice if the reaction is marked or persistent.
Darkening or blue-black marks
Stop and request assessment if the skin becomes persistently darker or develops blue-black marks. Prolonged hydroquinone use can cause ochronosis. Do not use a cream or gel that has turned dark or blackish.
Do not use if
- You are allergic to hydroquinone, tretinoin, kojic acid, niacinamide or the final vehicle
- You are pregnant, trying to conceive or breastfeeding
- The area has ochronosis, a suspicious or changing lesion, open wounds, eczema, marked irritation or sunburn
When to contact your doctor
- Facial swelling, breathing difficulty, widespread blistering, eye pain, light sensitivity or altered vision: seek urgent medical care
- You become pregnant or think pregnancy is possible: stop the formula and contact your clinician
- Persistent burning, swelling, cracks, crusts, worsening pigmentation or blue-black marks
Storage
Keep the compounded preparation in its labelled container, out of children's reach. Follow the pharmacy's storage conditions and beyond-use date; these depend on the final vehicle. Do not transfer it to another container.
What to expect
Pigment changes are gradual and recurrence is common without daily photoprotection. The formula is deliberately limited to 3 months. Use comparable photographs at review and expect the clinician to plan a break or a simpler maintenance routine rather than continuous use.
Sources
Questions while you're on treatment?
Message your doctor in your private chat about side effects, doses or anything that worries you. Replies in under 2 hours on average.
- Follow up on your skin treatment in the chat
- Download your e-prescription
- Renewals reviewed by your doctor
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