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Fluocinolone / hydroquinone / tretinoin topical Side Effects

In Summary

Commonly reported side effects of fluocinolone/hydroquinone/tretinoin topical include: burning sensation, desquamation, pruritus, erythema, and xeroderma. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to fluocinolone / hydroquinone / tretinoin topical: topical application cream

In addition to its needed effects, some unwanted effects may be caused by fluocinolone / hydroquinone / tretinoin topical. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking fluocinolone / hydroquinone / tretinoin topical:

More common:
  • Redness, peeling, drying, itching, or burning of the skin
Less common:
  • Darkening of normal skin color
  • irritated skin
  • rash
Incidence not known:
  • Blistering, crusting, or flaking of the skin
  • burning and itching of the skin with pinhead-sized red blisters
  • lightening of normal skin color
  • redness and scaling around the mouth
  • severe redness, soreness, or scaling of the skin
  • thinning of the skin with easy bruising

Minor Side Effects

Some of the side effects that can occur with fluocinolone / hydroquinone / tretinoin topical may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common:
  • Blemishes on the skin
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • pimples
  • raised, dark red, wart-like spots on the skin

For Healthcare Professionals

Applies to fluocinolone / hydroquinone / tretinoin topical: topical cream


Local side effects have been reported the most frequently. These have included erythema (41%), desquamation (38%), burning (18%), dryness (14%), pruritus (11%), inflammation (5.45%), nonspecific application site reaction (5%), acne (5%), telangiectasia (3%), pigmentary changes (2%), irritation (2%), papules (1%), acne-like rash (1%), rosacea (1%), rash (1%), and vesicles (1%).

Local side effects associated with fluocinolone topical have included burning, itching, or irritation, especially when applied to denuded skin. Long-term use of topical corticosteroids has resulted in skin atrophy and thinning, and the development of striae, telangiectasia, subcutaneous hemorrhage, and easy bruising and bleeding. Allergic contact dermatitis and perioral dermatitis/rosacea-like dermatitis has been occasionally reported with topical corticosteroid usage. In addition, topical corticosteroid use, such as fluocinolone, may inhibit local immune response rendering the skin more susceptible to infections. Reports of folliculitis have occasionally been associated with fluocinolone topical.

Local side effects associated with tretinoin topical have frequently included retinoid dermatitis which is characterized by local erythema, dryness, scaling, pruritus, and variable degrees of irritation.

Local side effects associated with hydroquinone have rarely included exogenous ochronosis.[Ref]

Pigmentary changes associated with fluocinolone-hydroquinone-tretinoin topical use are hyperpigmentation and hypopigmentation.

Skin atrophy, associated with fluocinolone, may become evident within one to two months of use and is due to the inhibitory effect of corticosteroids on collagen formation. Skin on the face, axillae, and groin appear to be most susceptible to the adverse, long-term effects of topical fluocinolone. Use of high potency topical corticosteroids on these areas should be minimized or avoided.

Perioral dermatitis or rosacea-like dermatitis has occurred in patients treated with potent topical corticosteroids who are of seborrheic skin type. This condition may flare temporarily upon discontinuation of topical steroids, prompting patients to continue their use. If topical corticosteroids are discontinued, this flare and the initial dermatitis generally resolves over a few weeks.

Local reactions associated with tretinoin topical are commonly observed during the initial phase of therapy, but may not appear until as late as ten weeks into treatment. The dermatitis generally subsides with prolonged use of the medication, although in some cases may require a dosage adjustment or discontinuation of therapy. True contact dermatitis has been reported and confirmed with patch testing and leukocyte migration inhibition studies, but is uncommon. Rarely, there may be temporary hyper- or hypopigmentation following repeated applications.

There are rare reports of exogenous ochronosis associated with hydroquinone therapy. The symptoms consist of a gradual blue-black darkening of the skin. The occurrence of this condition should prompt discontinuation of fluocinolone-hydroquinone-tretinoin topical therapy. The majority of the patients with this condition are Black; however, there are reports involving Caucasians and Hispanics.[Ref]


Dermatologic side effects associated with tretinoin topical have included peeling, dry skin, burning, stinging, erythema, pruritus, and skin irritation. Topical tretinoin may induce photosensitivity in some individuals, as well as an increased susceptibility to irritation from wind, cold, and dryness.[Ref]

Dermatologic side effects are the most frequently reported side effects associated with the use of tretinoin topical. In double-blind, vehicle-controlled studies involving 339 patients who applied tretinoin topical 0.02% to their faces, adverse reactions associated with the use of tretinoin topical were limited primarily to the skin. Almost all patients reported one or more local reactions such as peeling, dry skin, burning, stinging, erythema, and pruritus. In 24% of all study patients, skin irritation was reported that was either severe (about 7%), led to temporary discontinuation of tretinoin topical 0.02% (about 20%), or led to use of a mild topical corticosteroid. About 5% of patients using tretinoin topical 0.02%, compared to less than 1% of the control patients, had sufficiently severe local irritation to warrant short-term use of mild topical corticosteroids to alleviate local irritation. About 4% of patients had to discontinue use of tretinoin topical because of adverse reactions.

A severe cutaneous reaction was reported in a patient who had an ice pack placed over an area treated with topical tretinoin. The area became pigmented and indurated, and the pigmentation persisted for an extensive length of time.[Ref]

Nervous system

A patient with preexisting hepatic disease developed neurological side effects following 4 weeks of tretinoin topical administration. Symptoms included headache, memory loss, truncal ataxia, and dysarthria, all of which improved upon temporary discontinuation of medication and recurred when the patient resumed usage. Upon withdrawal of medication a second time, the symptoms resolved within 4 weeks.[Ref]

Nervous system side effects have included paresthesia (3%) and hyperesthesia (2%).

Nervous system side effects associated with tretinoin topical have included a single case of neurotoxicity.[Ref]


The rare suppression of the hypothalamic-pituitary-adrenal axis is more likely when higher potency topical corticosteroids are used over extensive areas and/or when occlusive dressings are applied.[Ref]

Endocrine side effects associated with fluocinolone topical have rarely included suppression of the hypothalamic-pituitary-adrenal axis.[Ref]


Ocular side effects associated with fluocinolone topical have rarely included glaucoma (1 case).

Ocular side effects associated with tretinoin topical have rarely included reversible ectropion. Transient, lasting approximately 30 to 60 seconds, and harmless stinging of the eye has been associated with tretinoin topical following application onto the skin surrounding the ophthalmic area.[Ref]

A young male developed glaucoma following application of a topical corticosteroid to his eyelids for a period of several years.[Ref]


Genitourinary side effects associated with tretinoin have included an isolated case of vaginal bleeding in a postmenopausal woman and confirmed upon rechallenge. Estrogen levels appeared not to have been affected.[Ref]


Hepatic side effects associated with tretinoin topical and oral have included reversible, clinically insignificant, changes in liver function tests including elevations in serum bilirubin, alkaline phosphatase, glutamic-oxaloacetic transaminase, and glutamic-pyruvic transaminase.[Ref]


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23. Tang SC, Chan KC, Chow SP "Osteonecrosis of femoral head after topical steroid therapy." J R Coll Surg Edinb 31 (1986): 321-3

24. Cubey RB "Glaucoma following the application of corticosteroid to the skin of the eyelids." Br J Dermatol 95 (1976): 207-8

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Not all side effects for fluocinolone / hydroquinone / tretinoin topical may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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