# Custom Prescription Treatments

## Melasma, Acne Scarring, Post-Inflammatory Hyperpigmentation (PIH) 

### **Single Compound Creams**

<table><thead><tr><th width="371">Medication</th><th>Treatment Duration</th></tr></thead><tbody><tr><td>Azaleic Acid (10% - 20%)</td><td>24 weeks</td></tr><tr><td>Adapalene (0.1% - 0.3%)</td><td>Continuous</td></tr><tr><td>Kojic Acid (1% - 4%) </td><td>12 weeks</td></tr><tr><td>Hydroquinone (2% - 4%)</td><td>12 weeks</td></tr><tr><td>Tretinoin (0.025% - 0.10%)</td><td>Continuous</td></tr><tr><td>Tazarotene (0.045% - 0.10%)</td><td>Continuous</td></tr><tr><td>Tranexamic Acid Cream (3% - 5%)</td><td>12 weeks</td></tr><tr><td>Vitamin C (10% - 20%)</td><td>Continuous</td></tr></tbody></table>

### **Dual Combination Compounds**

| Medication                              | Duration |
| --------------------------------------- | -------- |
| Dexamethasone (0.1%), Hydroquinone (4%) | 12 weeks |
| Hydrocortisone (1%), Hydroquinone (4%)  | 12 weeks |

### **Triple Combination Compounds**

<table><thead><tr><th width="585">Medication</th><th>Duration</th></tr></thead><tbody><tr><td>Kojic Acid (2%) + Glycolic Acid (10%) + Hydroquinone (2%)</td><td>12 weeks</td></tr><tr><td>Tretinoin (0.1%), Dexamethasone (0.1%), Hydroquinone (4%)</td><td>12 weeks</td></tr><tr><td>Tretinoin (0.05%), Fluocinolone (0.01%), Hydroquinone (4%) </td><td>8 weeks</td></tr><tr><td>Tretinoin (0.05%), Hydrocortisone (1%), Hydroquinone (4%) </td><td>12 weeks</td></tr></tbody></table>

### **Quadrule Combination Compounds**

<table><thead><tr><th width="620">Medication</th><th>Duration</th></tr></thead><tbody><tr><td>Tretinoin (0.025%), Fluocinolone (0.01%), Hydroquinone (4%), Kojic Acid (4%)</td><td>12 weeks</td></tr><tr><td>Tretinoin (0.025%), Hydrocortisone (1%), Hydroquinone (4%), Kojic Acid (4%)</td><td>12 weeks</td></tr></tbody></table>

## Skin Brightening and Texture

| Medication                  | Duration   |
| --------------------------- | ---------- |
| Adapalene (0.1% - 0.3%)     | Continuous |
| Azaleic Acid (10% - 20%)    | 24 weeks   |
| Kojic Acid (1% - 4%)        | 12 weeks   |
| Tazarotene (0.045% - 0.10%) | Continuous |
| Tretinoin (0.025% - 0.10%)  | Continuous |
| Vitamin C (10% - 20%)       | Continuous |
| Hydroquinone (2% - 4%)      | 12 weeks   |

## Finding a Compounding Pharmacy

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<summary>Can any pharmacy in Ontario make a custom cosmetic cream?</summary>

No, not all pharmacies in Ontario are equipped to create custom cosmetic products. Compounding pharmacies are specially licensed to make personalized formulations, including custom skincare. These pharmacies have the expertise and facilities to safely mix and prepare creams with specific ingredients, concentrations, and bases.

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## Miscellaneous Questions

<details>

<summary>What goes into a custom cosmetic cream?</summary>

Custom creams typically include:

* **Active Ingredients**: These are the components that address specific concerns, like retinoids for fine lines, vitamin C for brightness, or salicylic acid for acne.
* **Bases**: The base is the cream’s main structure, affecting texture, absorption, and feel on your skin. Depending on your skin type, you can choose from lightweight gels, rich moisturizers, or other options tailored to your needs.

A skin specialist or compounding pharmacist will work with you to select the ideal ingredients and base to match your skincare goals.

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## References

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<summary>Reference Studies</summary>

**Dayal et al**

* Dayal S, Sahu P, Dua R. Combination of glycolic acid peel and topical 20% azelaic acid cream in melasma patients: efficacy and improvement in quality of life. J Cosmet Dermatol. 2017; 16(1):35-42. <https://doi.org/10.1111/jocd.12260>

**Kodali et al**

* Kodali S, Guevara IL, Carrigan CR, et al. A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women. J Am Acad Dermatol. 2010;63(6):1030-1035. <https://doi.org/10.10> 16/j.jaad.2009.12.027

**Lim et al**

* Lim J. T. (1999). Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. *Dermatologic surgery : official publication for American Society for Dermatologic Surgery \[et al.]*, *25*(4), 282–284. <https://doi.org/10.1046/j.1524-4725.1999.08236.x>

**Ahmad et al**

* Ahmad Nasrollahi, S., Sabet Nematzadeh, M., Samadi, A., Ayatollahi, A., Yadangi, S., Abels, C., & Firooz, A. (2019). Evaluation of the safety and efficacy of a triple combination cream (hydroquinone, tretinoin, and fluocinolone) for treatment of melasma in Middle Eastern skin. *Clinical, cosmetic and investigational dermatology*, *12*, 437–444. <https://doi.org/10.2147/CCID.S202285>

**Bertold et al**

* Bertold C, Fontas E, Singh T, Gastaut N, Ruitort S, Wehrlen Pugliese S, et al. Efficacy and safety of a novel triple combination cream compared to Kligman's trio for melasma: A 24-week double-blind prospective randomized controlled trial. *J Eur Acad Dermatol Venereol*. 2023; 37: 2601–2607. <https://doi.org/10.1111/jdv.19455>

**Naseemullah et al.**

* Naseemullah, Khan, A. Q., Khan, F. A., Awan, S. R., & Khan, S. R. (2022). Efficacy of 2% kojic acid containing formulation vs picosecond laser for treatment of melasma. *Pakistan Journal of Medical & Health Sciences, 16*(10), 368. <https://doi.org/10.53350/pjmhs221610368>

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