From the FDA Drug Label
INDICATIONS AND USAGE HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation. The role of Triple Combination Cream (TCC) containing fluocinolone acetonide, hydroquinone, and tretinoin in treating hyperpigmentation, specifically melasma, is to gradually bleach the hyperpigmented skin areas.
- The hydroquinone component is specifically indicated for this purpose, as stated in the drug label 1.
- TCC is used to treat melasma by reducing the appearance of hyperpigmentation.
- It is essential to note that TCC should be used under medical supervision, as it contains multiple active ingredients that may have side effects or interact with other medications.
From the Research
Triple Combination Cream (TCC) containing fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% is considered a first-line treatment for melasma and other forms of hyperpigmentation, as it has been shown to be effective in reducing excess pigmentation and improving patient outcomes, as demonstrated in a comprehensive review of its long-term and short-term treatment efficacy 2.
Mechanism of Action
This formulation works through multiple mechanisms to reduce excess pigmentation:
- Hydroquinone inhibits tyrosinase (the enzyme responsible for melanin production)
- Tretinoin increases cell turnover and enhances penetration of hydroquinone
- Fluocinolone acetonide (a mild corticosteroid) reduces inflammation that can worsen hyperpigmentation
Treatment Regimen
The typical regimen involves applying a thin layer to affected areas once daily, usually at bedtime, for 8-12 weeks, as supported by a randomized controlled trial comparing the efficacy and safety of TCC with hydroquinone 4% cream in Asian patients with moderate to severe melasma 3.
Maintenance Therapy
After this initial treatment period, maintenance therapy is often necessary, which may involve using the cream intermittently (2-3 times weekly) or switching to less potent alternatives to prevent side effects, as suggested by a study on the sequential treatment with triple combination cream and intense pulsed light 4.
Sun Protection
Patients should always use broad-spectrum sunscreen (SPF 30+) during the day while using this treatment, as sun exposure can worsen melasma and reduce treatment efficacy, as highlighted in a review of melasma treatment options 5.
Side Effects
Common side effects include mild irritation, redness, and dryness, which typically improve with continued use, as reported in a study on the safety and efficacy of TCC in patients with melasma 2.
Recent Evidence
A recent study found that the addition of oral tranexamic acid to TCC did not significantly contribute to a decrease in Melasma Area Severity Index (MASI) score, suggesting that TCC alone remains a effective treatment option for melasma 6.