Pricing & Options
Request pricing and we'll email you details
Available Strengths
Select your type to view pricing options
Active Ingredients
Important Disclaimer
These statements have not been evaluated by the Food and Drug Administration (FDA). Compounded products are not FDA-approved and are not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. The information provided is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting any new treatment.
Clinical Information
Evidence-based details for healthcare providers
Wash and dry the affected skin 30 minutes before application to reduce irritation. At bedtime, apply a pea-sized amount to the entire affected area, not just individual spots, using clean fingertips. For the first 2 weeks, use every other night. If skin tolerates, increase to once nightly. Do not exceed one application in 24 hours. Avoid eyes, nostrils, and mouth. Children under 12 and adults over 65 should start with every third night and increase as advised by their prescriber. If you miss a dose, skip it and resume the next night—do not double-apply. Treatment usually lasts 8–16 weeks; your prescriber will tell you when to stop or taper.
Hydroquinone blocks an enzyme called tyrosinase, which the skin needs to make melanin (pigment). Less melanin means dark patches fade over several weeks. Tretinoin speeds up skin cell turnover, so the old pigmented cells shed faster and hydroquinone can reach deeper layers. Hydrocortisone is a mild anti-inflammatory steroid that calms redness and itching that sometimes occur with the other two medicines. Most people begin to notice lightening in 4–6 weeks, with full benefit by 12–16 weeks if used nightly and combined with sun protection. The brightening effect lasts as long as new pigment is not triggered by sun or hormones.
Do not use if you are allergic to hydroquinone, tretinoin, hydrocortisone, other steroids, or any ingredient in this cream (may cause rash or swelling). Do not apply to broken, sunburned, or infected skin—this can increase absorption and side effects. Do not use if you are pregnant or planning to become pregnant; tretinoin can harm an unborn baby. Avoid while breastfeeding because safety in nursing infants is unknown. Not for children under 12 years unless directed by a dermatologist. People with eczema, rosacea, or chronic skin thinning should ask their doctor before use.
Using other skin products with alcohol, benzoyl peroxide, salicylic acid, alpha- or beta-hydroxy acids, or products containing retinol can increase dryness and irritation—space them at least 12 hours apart or avoid. Topical antibiotics like clindamycin are usually safe but may raise irritation when layered; apply at a different time of day. Oral or injectable steroids may add to hydrocortisone effects; tell your prescriber if you take them. Skin-sensitizing treatments (chemical peels, laser, waxing) can worsen irritation—pause this cream 1 week before and after such procedures. Limit alcohol and nicotine, which may slow skin healing.
Very common (more than 1 in 10 users): mild redness, peeling, dryness, and stinging during the first 2–4 weeks; these usually lessen as skin adapts. Common (1–10 in 100): temporary darkening of spots (paradoxical darkening) in the first few weeks, mild burning, or itching. Uncommon (1–10 in 1,000): severe redness, swelling, blistering, or skin thinning—stop use and contact your prescriber. Rare but serious: allergic reaction with hives, facial swelling, or trouble breathing (seek emergency help). Most minor side effects improve within a week after reducing frequency or applying a light moisturizer 10 minutes after the cream.
Store tightly closed at room temperature 68-77°F (20-25°C). Keep away from heat sources, direct sunlight, and moisture (do not store in bathroom). Do not freeze. Use within 90 days of compounding for best potency. Keep out of reach of children. Dispose of any leftover or expired cream through a pharmacy take-back program or in a sealed bag mixed with coffee grounds before placing in household trash.
Frequently Asked Questions
How long before I see my dark spots fade?
Most people start to notice a lighter tone in 4–6 weeks. Full lightening often takes 12–16 weeks of nightly use plus good sun protection. If you see no change by week 12, talk to your prescriber.
What should I do if my skin becomes very red or flaky?
Skip the next night’s dose and apply a gentle, fragrance-free moisturizer. When redness improves, restart every third night and slowly work back to nightly use if tolerated. Call your prescriber if severe irritation does not improve in a few days.
Can I wear makeup or other skincare products with this cream?
Yes, but apply this cream only at bedtime on clean skin. In the morning, wash it off, then use moisturizer, sunscreen (SPF 30 or higher), and makeup. Avoid using other strong exfoliants or retinol products at the same time without your provider’s advice.
Why is sunscreen so important while using this medication?
The cream makes your skin more sensitive to sunlight. Even brief sun exposure can darken spots again or cause irritation. Apply broad-spectrum SPF 30+ every morning and reapply every 2 hours when outdoors.
Is it safe to use during pregnancy or while breastfeeding?
No. Tretinoin has been linked to birth defects, and hydroquinone absorbs through the skin. Stop the cream and tell your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding.
Can I keep using the cream after my spots fade?
Your provider may have you taper to 2–3 nights a week or stop for a few months to prevent skin thinning. Long-term daily use is usually not recommended without breaks. Always follow your prescriber’s plan.
What happens if I get the cream in my eyes or mouth?
Rinse right away with plenty of cool water. If burning or irritation continues after 10 minutes, seek medical advice. Keep the cream away from eyes, lips, and inside the nose.
Related Products
Coal Tar Cream
Coal Tar Cream 10% is put on the skin to help calm itching, scaling, and flaking seen with psoriasis, eczema, and seborrheic dermatitis. It slows the rapid growth of skin cells, reduces redness, and eases discomfort so skin can heal.
Calcipotriene | Fluorouracil Cream
Calcipotriene | Fluorouracil Cream combines a vitamin D-like medicine (calcipotriene) with a cancer-fighting medicine (fluorouracil). Together they target rough, sun-damaged spots on the skin called actinic keratoses. Calcipotriene helps your immune system recognize damaged cells, while fluorouracil destroys those cells so new, healthy skin can grow. This prescription cream is applied to affected skin as directed by your healthcare provider.
Salicylic Acid | Trichloroacetic Acid (TCA) Solution
Salicylic Acid and Trichloroacetic Acid (TCA) topical solution is a compounded chemical peel used by trained healthcare professionals to exfoliate the outer layers of skin. It may be used in-office for cosmetic skin resurfacing concerns such as uneven texture and the look of blemish-prone or sun-damaged skin. This product is for topical use only and should be applied only as directed by a licensed clinician due to the risk of burns, pigment changes, and scarring.
Metformin Cream
Compounded topical metformin cream is prepared by a licensed pharmacy for skin conditions such as acne, rosacea, eczema, and psoriasis when your healthcare provider believes standard treatments are not enough or not well-tolerated. It is not an FDA-approved product for skin use, but it is made under pharmacy compounding regulations for individual patients with a valid prescription.