Hydroquinone for Melasma in the UK: What a Dermatologist Wants You to Know
Short answer: Hydroquinone is one of the most studied creams for melasma and remains a reference treatment in dermatology. In the UK it is not allowed in cosmetics. It is a prescription-only medicine, so the only safe and legal way to use it is under a doctor's supervision, for a limited period and as part of a wider plan to keep melasma away.
I have treated hyperpigmentation for 15 years, and hydroquinone is the treatment patients ask me about most. It is also one that people often misuse. This guide explains what it does, who it suits and how to use it safely.
What is hydroquinone and how does it work?
Melasma is caused by overactive pigment cells (melanocytes) producing too much melanin, usually on the cheeks, forehead, upper lip and chin. Hydroquinone blocks tyrosinase, the enzyme melanocytes need to make melanin. Less new pigment is produced, and the existing patches gradually fade as the skin renews itself.
Because it works on new pigment production, results are gradual. Most people notice the first change after 4–8 weeks. The full effect of a course is usually judged at around 8–12 weeks.
Is hydroquinone legal in the UK?
Hydroquinone has been banned in cosmetic products in the UK and EU since 2001. It can still be used as a medicine, which means a doctor must prescribe it after assessing your skin.
This matters because "skin lightening" creams sold on market stalls, social media and some websites are illegal. Trading Standards regularly seize products containing undeclared hydroquinone, strong steroids or even mercury. These can cause thinning skin, stretch marks, rebound pigmentation and, with long use, permanent damage. If a hydroquinone cream is sold to you without any medical questions, it should not be on sale.
Does hydroquinone work for melasma?
Yes. It is one of the most researched topical treatments for melasma and has been used for decades. Dermatologists often combine it with a retinoid and a mild steroid. This "triple combination" approach, first described by Kligman in 1975, works faster than any one of the three ingredients alone in clinical trials.
It is important to be honest about one thing: melasma is a chronic condition. Hydroquinone can fade it significantly, but it does not switch off the tendency to pigment. Sun, visible light, heat and hormones can bring it back. That is why the plan after hydroquinone matters as much as the hydroquinone itself.
How doctors usually use hydroquinone
Strength: usually 2–4%. Higher strengths increase the risk of irritation and side effects without a clear extra benefit for most people.
Application: once a day, normally at night, as a thin layer on the affected areas or the whole pigmented zone.
Duration: a defined course, typically around 3 months, then a review. It is not a cream to use indefinitely.
Maintenance: after the course, pigment is kept under control with non-hydroquinone treatments and strict daily sun protection.
Follow-up: photos and a review every few months, so the plan can be adjusted before pigment returns.
Side effects and risks
Irritation: redness, dryness, stinging or itching, especially in the first weeks or when combined with a retinoid.
Allergic contact dermatitis: uncommon, but the cream should be stopped if the skin becomes very itchy or swollen.
Uneven lightening: a pale "halo" around treated patches if the cream is applied to normal skin for long periods.
Exogenous ochronosis: a rare, blue-grey or blue-black darkening that can be hard to reverse. A 2022 systematic review of 126 reported cases found that most involved hydroquinone above 4% or of unknown strength, used for long periods (a median of 5 years). Only a handful of cases followed courses of 3 months or less. This is the main reason a supervised, time-limited course matters.
Hydroquinone is not recommended during pregnancy or breastfeeding. Tell your doctor about any other creams or medicines you use.
Hydroquinone in darker skin
Melasma is common in people with brown and Black skin, and these are also the skin types most at risk from irritation, which can itself leave dark marks (post-inflammatory hyperpigmentation). Ochronosis has also been reported more often in darker skin. In my practice, darker skin needs a gentler start, careful strength choice and closer follow-up, but it can be treated very successfully.
What comes after hydroquinone?
A good plan has three stages: clear, control and maintain. After a hydroquinone course, pigment is usually kept down with a combination of:
daily broad-spectrum SPF 50, ideally a tinted sunscreen containing iron oxides, which also helps against visible light;
a retinoid (see Retinol vs tretinoin for melasma);
non-hydroquinone brighteners such as azelaic acid, vitamin C or tranexamic acid, chosen for your skin;
in stubborn cases, carefully selected in-clinic treatments such as gentle peels or specific lasers.
How can I get hydroquinone in the UK?
Because hydroquinone is a prescription-only medicine, you cannot simply buy it. You need an assessment by a UK-registered doctor, either face to face or through a proper online review that includes photos, your medical history and the medicines you take. A doctor should confirm the diagnosis first. Some patches that look like melasma are sun damage, post-inflammatory marks or, occasionally, something that needs a different treatment altogether.
With my online skin review, the process works like this, wherever you live in the UK:
Fill in a short online form with a few questions about your skin, your health and the products you have used, and upload clear photos of the pigmented areas.
I review your case personally. If I need more information or extra photos, I will email you.
You receive your plan by email. If a prescription treatment is right for you, I explain what it is, how to use it and what it costs. If it is not suitable, I tell you why and suggest safer alternatives.
You pay only if treatment is prescribed. The review itself is free.
Your treatment is posted to your door, with clear instructions on how to use it.
Follow-up: I review your progress with new photos, adjust the plan and move you onto maintenance at the right time.
In my Benar Pigment Protocol™, a prescription cream is only one part of the plan. It is combined, where suitable, with oral treatment and a chemical peel, then followed up every 3 months so the pigment does not return. You can read more on my melasma treatment page.
Frequently asked questions
Is hydroquinone banned in the UK?
It is banned in cosmetics. It is allowed as a prescription medicine, prescribed by a doctor after an assessment.
Can I buy hydroquinone over the counter?
No. Any hydroquinone cream sold without a prescription in the UK is being sold illegally, and its contents may not match the label.
How can I get hydroquinone cream in the UK?
Through a UK-registered doctor. You can see a doctor in person, or complete my free online skin review from anywhere in the UK. If treatment is prescribed, it is posted to your home and you only pay at that point.
How long can I use hydroquinone?
Usually as a course of around 3 months, followed by a review and a maintenance plan without hydroquinone. Long, unsupervised use is linked to side effects such as ochronosis.
Will my melasma come back after hydroquinone?
It can, because melasma is chronic. Daily sun protection and a maintenance routine greatly reduce the chance of it returning.
Is hydroquinone safe for dark skin?
It can be used in darker skin under supervision, with a careful strength choice, a gentle start and close follow-up.
Can I use hydroquinone during pregnancy?
It is not recommended during pregnancy or breastfeeding. Safer options can be discussed with your doctor.
Free online skin review
If you live anywhere in the UK and think you have melasma, you can send me your photos and history through a short online form. I review every case personally. Nothing is charged unless treatment is prescribed for you.
References
Ishack S, Lipner SR. Exogenous ochronosis associated with hydroquinone: a systematic review. Int J Dermatol. 2022;61(6):675–684.
Kligman AM, Willis I. A new formula for depigmenting human skin. Arch Dermatol. 1975;111(1):40–48.
Taylor SC, et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis. 2003;72(1):67–72.
Rajaratnam R, et al. Interventions for melasma. Cochrane Database Syst Rev. 2010;(7):CD003583.
Southwark Council Trading Standards. Illegal skin lighteners.
About the author: Dr Hasan Benar is a dermatologist at 54 Harley Street, London. He has treated hyperpigmentation and melasma for 15 years, including extensive experience in darker skin types, and offers online skin reviews across the UK. This article is for general information and is not a substitute for a medical consultation.
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