If your dermatology prescriber mentions a compounded cream, gel, or lotion, you probably have questions. What does compounded mean? Why this and not something from the shelf? And what does a compounding pharmacy actually do for conditions like acne, melasma, or rosacea? Here is how it works, in plain terms.

What a compounded topical is

A compounded medication is prepared by a pharmacist for one specific patient, based on a prescription from a licensed prescriber. A pharmacy can adjust the strength, combine ingredients the prescriber has chosen into a single product, or prepare a form (cream, gel, lotion, foam, or solution) that suits the patient and the area being treated.

Compounded medications are not FDA-approved finished drug products. They are prepared only after a prescriber decides that a patient-specific formulation is appropriate for you.

Why a prescriber might choose one

The decision belongs to your prescriber, and the reasons vary by patient:

• A commercial product may not come in the strength your prescriber wants.
• Your prescriber may want two or three ingredients in one product, so you apply one cream instead of several.
• A commercial product may contain an inactive ingredient that does not suit you.
• The available form may be hard to use on the area being treated.

Your prescriber can explain which of these, if any, applies to you.

Acne

Acne is the most common skin condition in the United States, affecting nearly 50 million Americans each year. The American Academy of Dermatology’s current guidelines strongly recommend topical benzoyl peroxide, topical retinoids (such as tretinoin and adapalene), and topical antibiotics, along with oral doxycycline when needed. The guidelines also encourage combining topical treatments that work in different ways, and they list azelaic acid and spironolactone among the options a prescriber may consider.

That combination approach is one reason prescribers turn to compounding. When your prescriber orders it, Pharmaconic compounds acne preparations including:

• Azelaic acid 15% / niacinamide 4% cream
• Azelaic acid 18%
• Clindamycin 1% / niacinamide 4% cream
• Clindamycin 1% / niacinamide 4% / benzoyl peroxide 3% cream
• Benzoyl peroxide 5% / clindamycin 1% / tretinoin 0.01% lotion
• Dapsone 5% / niacinamide 2% cream
• Dapsone 5% / azelaic acid 5% topical solution
• Spironolactone 5% / dapsone 2% / niacinamide 2% cream

We also fill commercial acne prescriptions, including benzoyl peroxide washes and gels, adapalene, tretinoin, clindamycin, doxycycline, minocycline, spironolactone tablets, and isotretinoin.

Melasma and hyperpigmentation

Melasma causes brown or gray-brown patches, most often on the face. It tends to be long-lasting, and sun exposure can make it worse, which is why prescribers pair treatment with daily sun protection. Hydroquinone, used alone or in a triple combination with tretinoin and a mild corticosteroid, is widely described in the medical literature as a first-line treatment. Because these medications are used for a limited time and under supervision, your prescriber will tell you how long to apply yours.

When your prescriber orders it, Pharmaconic compounds:

• Hydroquinone 6% to 8%
• Hydroquinone 4% to 6% / tretinoin 0.05% / ascorbic acid 1% cream
• Hydroquinone 8% / kojic acid 4% / tretinoin 0.1% cream
• Hydroquinone 4% / fluocinolone 0.02% / tretinoin 0.05% gel

We also fill commercial prescriptions for hydroquinone 4% cream and Tri-Luma.

Rosacea

Rosacea is a chronic condition that causes facial redness, flushing, and sometimes acne-like bumps. Treatment usually combines gentle skin care, sun protection, and avoiding personal triggers with prescription medication. Topical metronidazole and azelaic acid are two of the best-studied topical treatments for the bumps and pimples of rosacea.

When your prescriber orders it, Pharmaconic compounds an azelaic acid 15% / metronidazole 1% cream, which puts both ingredients in one product. We also fill commercial prescriptions for metronidazole 0.75% cream, azelaic acid 15% gel, sodium sulfacetamide wash, and doxycycline.

Other dermatology prescriptions we prepare

Beyond these three conditions, Pharmaconic compounds prescription preparations for hair loss (minoxidil-based foams and solutions), warts, scars, aging skin, undereye concerns, excessive sweating, and topical numbing before procedures. We also dispense a broad list of commercial dermatology medications, including topical corticosteroids and antifungals. If your prescriber has written for something not mentioned here, call us and we will tell you whether we can fill it.

What happens after the prescription is written

1. Your prescriber e-prescribes or faxes the prescription to Pharmaconic.
2. A pharmacist verifies it and may contact your prescriber’s office with questions about the formulation.
3. We contact you to confirm the order and answer your questions.
4. Your medication is prepared, labeled with your name and directions, and delivered to your door free of charge, within 24 hours of confirmation.

Compounded medications are not covered by insurance. Pharmaconic offers affordable cash pricing, and no prior authorization is needed. Pricing varies by formulation, so we will route price questions to Stan for a specific quote.

Questions worth asking

Ask your prescriber why a patient-specific formulation was chosen for you, how long to use it, and what results and side effects to expect. Ask the pharmacist how to store it, how to apply it, and what to do if you notice irritation. Our pharmacists are available for consultations.

Follow the directions on your label, and contact your prescriber if anything about your skin changes or concerns you. If you are pregnant, planning a pregnancy, or breastfeeding, tell your prescriber before you start any skin medication. If you are unsure about a label or an instruction, call the pharmacy before you use the product.

Compounded medications are patient-specific preparations and are not FDA-approved finished drug products. All formulations require a valid prescription from a licensed prescriber. This is general patient education, not individual medical advice.