Cream
Acne Cream
Triple-action topical for acne: antibiotic (clindamycin + erythromycin) and antifungal (ketoconazole). Covers bacterial and fungal acne.
Starting at $101/mo
MelasmaTriple combinationShort course
Hydroquinone / Tretinoin / Hydrocortisone Cream
RxPrescription onlyApplied to the skin · Once a day · Melasma · Triple combination · Short course
Starting at $94/mo
A triple-combination prescription cream for melasma: hydroquinone 6% to slow pigment, tretinoin 0.025% to speed skin renewal and hydrocortisone 2.5% to calm irritation. Applied once at bedtime for a short course, usually up to 8 weeks.
Choose your plan
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- The three-ingredient approach dermatologists use for melasma
- Tretinoin speeds skin renewal so pigmented cells shed faster
- A short course of about 8 weeks, then your physician plans maintenance
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is this cream?
(hydroquinone 6% + tretinoin 0.025% + hydrocortisone 2.5%)
It follows the classic triple combination for melasma: hydroquinone slows melanin production, tretinoin speeds up skin renewal, and a corticosteroid calms the irritation the other two cause. Because of the tretinoin and the steroid, it is meant for a short course, not for continuous use, and it must not be used during pregnancy.
- How it is taken
- Applied to the skin
- How often
- Once a day
- Form
- Melasma · Triple combination · Short course
8 weeks
the usual course for a triple-combination cream
The FDA-approved triple combination for melasma is labeled for up to 8 weeks. Melasma often returns after stopping, so daily sunscreen and a gentler maintenance plan matter.
How it works,
week by week.
Week 1
Your physician assesses your pigmentation pattern and recommends the right strength. Start with the gentlest option; escalate if needed.
Week 4–6
Fading usually starts to show. With the combinations, redness and peeling are common in these weeks.
Month 2–3
The triple combination ends its course at about 8 weeks. Hydroquinone alone keeps fading the spots gradually.
After the course
Your physician ends the course and plans the break and the maintenance. SPF 30+ daily, always.
What you may notice,
and when.
Sun protection critical
pigmentation will rebound without SPF 30+
Gradual lightening
results take weeks to months; patience essential
Ochronosis risk
rare, with long continuous use; that is why it is used in courses
Even tone
results continue refining; maintenance is ongoing
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
These creams contain hydroquinone and are prescription treatments. Do not use them if you are pregnant, trying to become pregnant or breastfeeding; the triple combination also contains tretinoin, which must not be used in pregnancy. Two of them contain hydrocortisone, a corticosteroid: used longer than prescribed it can thin the skin. Do not use them if you are allergic to hydroquinone, kojic acid or sulfites, and tell your physician if you have asthma. Apply only to the dark spots, never on broken or irritated skin, and keep away from the eyes and lips. Use a broad-spectrum SPF 30+ every day. Hydroquinone is used in courses with breaks: with long continuous use it can rarely cause ochronosis, a blue-black darkening of the skin. If the treated skin gets darker instead of lighter, stop and contact your physician. A new or changing mole or spot needs an in-person check, not a brightening cream.
The research behind
hydroquinone.
Hydroquinone is a prescription skin lightener used for melasma. Its strongest trial evidence is for triple combinations with a retinoid and a steroid; the cream alone has fewer and older comparisons.
- Triple cream26.1% vs 4.6%
Two 8-week investigator-blind trials in 641 mostly female adults with melasma. At week 8, 26.1% of the triple cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone 0.01%) had complete clearing, against 4.6% in the dual-combination groups combined.
Taylor et al., Cutis 2003;72(1):67-72 - Against kojic acidfaster at week 4
Hydroquinone 4% against kojic acid 0.75% for facial melasma: hydroquinone responded earlier, by week 4, and was superior at the end of 12 weeks.
Monteiro et al., Indian J Dermatol 2013;58(2):157 - Ratingstrong for triple
A systematic review of 35 randomized trials of topical melasma treatments gave strong recommendations to cysteamine, triple combination therapy and tranexamic acid. Hydroquinone alone was not in that top group.
Austin et al., J Drugs Dermatol 2019;18(11)
What the studies found
- Triple cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone 0.01%) gave complete clearing in 26.1% at week 8 vs 4.6% for dual combinations (Taylor et al., Cutis 2003).
- Hydroquinone 4% responded earlier than kojic acid 0.75% and was superior by week 12 in facial melasma (Monteiro et al., Indian J Dermatol 2013).
- A systematic review rated the triple combination as a strong recommendation for melasma (Austin et al., J Drugs Dermatol 2019).
Trial results are for the stated strengths of each ingredient; the triple-cream trial used 4% hydroquinone, while the creams in the catalog are 6% and 8%. Hydroquinone is a prescription drug; these are the pharmacy's versions, and compounded versions were not studied.
What this does not say
- The review notes that triple combination agents carry a theoretical risk of ochronosis, a darkening of the skin with long-term use.
- The triple-cream trial enrolled Fitzpatrick skin types I to IV over eight weeks; longer use was not measured.
- Results of combination creams are not results for hydroquinone alone, and we did not find trials of the 6% and 8% strengths in the catalog.
The research
behind it.
In clinical trials, triple-combination creams (hydroquinone, tretinoin and a corticosteroid) cleared or nearly cleared melasma in more patients than any of their ingredients alone.
The trade-off is irritation and sun sensitivity: redness, peeling and dryness are common in the first weeks. Used longer than prescribed, the steroid can thin the skin.
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I use Hydroquinone / Tretinoin / Hydrocortisone Cream?
Applied to the skin, once a day, at bedtime. The starting prescription is 1 mL each time. Your physician sets your own dose and it is printed on your label.
What exactly is in it?
Hydroquinone 6%, Tretinoin 0.025%, Hydrocortisone 2.5%.
How much arrives in each shipment?
1 tube at the starting strength, shipped to your door from a licensed US pharmacy.
Should I use this or hydroquinone alone?
Your physician decides with you. The triple combination works faster on stubborn melasma but irritates more and is limited to a short course; hydroquinone alone is gentler and is used in longer courses with breaks.
Why use cycles with hydroquinone?
Long continuous use increases the risk of ochronosis, a blue-black darkening that is hard to reverse. Courses with breaks, set by your physician, keep the benefit and lower that risk. Creams with a corticosteroid or tretinoin have shorter courses.
Can I use brightening creams in summer?
Yes, but SPF protection becomes even more critical. Sun exposure reverses all progress and worsens melasma. Consider higher SPF (50+) and protective clothing in summer.
What if brightening cream makes my skin darker?
Rebound hyperpigmentation can occur if you discontinue hydroquinone abruptly or skip sun protection. Gradual tapering and consistent SPF prevent this. If darkening occurs, contact your physician.
Can I combine brightening cream with other actives?
Space them: hydroquinone or tretinoin at night, vitamin C or other actives in the morning, at least 12 hours apart. Avoid mixing hydroquinone with strong exfoliants until your skin adapts.
Hydroquinone / tretinoin / hydrocortisone educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
More options
in this area.
Cream
Acne Cream with Tretinoin
Acne treatment combining antibiotics (clindamycin/erythromycin/ketoconazole) with tretinoin for faster clearance and post-acne healing.
Starting at $101/mo
Cream
Brightening Cream
Stronger prescription cream for stubborn melasma and dark spots: hydroquinone 6% with tretinoin, hydrocortisone, kojic acid and vitamins C and E. A short course, usually up to 8 weeks.
Starting at $109/mo
Cream
Clarity Cream
Acne and post-acne formula combining azelaic acid, niacinamide, clindamycin, and tretinoin. Anti-inflammatory and cell-renewing.
Starting at $109/mo
References
- 1.Hydroquinone in melasma: efficacy, safety, and ochronosis risk with long-term use. J Am Acad Dermatol, 2014
- 2.Combination depigmenting therapies in melasma: a systematic review. Dermatol Ther, 2019
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.