Custom Prescription Treatments#

A compounded cream is mixed by a pharmacy specifically for you. The pharmacy combines one or more active ingredients with a cream or gel base. Compounded creams are useful for cosmetic dermatology because they let the clinician match the active ingredient, strength, and base to your skin type and concern - something that off-the-shelf products cannot do.

Most regular Canadian pharmacies do not compound. You may need to use a compounding pharmacy specifically. Your clinician can suggest options, or you can ask any pharmacy whether they compound or can refer you.

• Active ingredients - the components that do the clinical work (for example, a prescription brightening agent, a prescription retinoid, a mild prescription steroid, or an anti-inflammatory brightening ingredient)
• Base - the cream, gel, or lotion that carries the active ingredients, affects how the cream feels, and how well it absorbs. Common bases include moisturizing cream bases suitable for sensitive facial skin.

Compounding lets the clinician:

• Match the strength to your skin (gentler for sensitive skin, stronger for stubborn pigmentation)
• Combine two or three active ingredients into one product (faster, more convenient)
• Choose a base that suits your skin type (richer for dry skin, lighter for oily skin)
• Avoid an ingredient you are sensitive to

Off-the-shelf prescription products are fixed in strength and combination. Compounding gives the clinician the flexibility to tailor.

Most compounded cosmetic creams are not covered under provincial drug plans and are self-pay. Some private drug plans cover compounded prescriptions in whole or in part. Ask your compounding pharmacy for a quote before filling.

For more on the three-component "triple therapy" approach, see the dedicated page.

• Mild irritation, dryness, peeling, or redness, especially in the first 2 to 4 weeks
• Increased sensitivity to sunlight - daily broad-spectrum sunscreen is required during treatment with most of these regimens
• Stinging on application, particularly with antioxidant creams and chemical exfoliants

If irritation is severe, stop the cream and follow up with your clinician for an adjustment (different strength, different base, less frequent application, or a different active).

• Prescription brightening creams are typically used for limited courses (often up to 12 weeks) with breaks afterwards. Long, continuous use can cause a rare bluish-grey darkening (the opposite of what the cream is intended to do).
• Mild prescription steroids (in some combination creams) are time-limited because prolonged daily use on the face can cause skin thinning, visible small blood vessels, and rebound redness when stopped.
• Prescription retinoids are not safe in pregnancy.
• Prescription brightening creams are generally not safe in pregnancy or while breastfeeding. Tell your clinician if you are pregnant, planning to become pregnant, or breastfeeding.

Your clinician chooses the active ingredient, strength, and duration to balance results against these risks for your situation.

Yes, when matched correctly. The clinician typically starts at a lower strength and titrates up to reduce the risk of post-inflammatory hyperpigmentation. Daily sunscreen with visible-light protection (tinted formulas containing iron oxide) is part of every plan.

If you are pregnant, breastfeeding, or planning a pregnancy, tell your clinician at intake. Pregnancy-safer alternatives include:

• An anti-inflammatory brightening cream (generally considered low-risk)
• Topical vitamin C (generally considered low-risk)
• Niacinamide (safe in pregnancy)
• Gentle exfoliation routines

Prescription retinoids, prescription brightening creams, and triple-therapy combinations are usually avoided in pregnancy.

A compounding pharmacy typically mixes the prescription within a few business days of receiving it. Shipping time depends on the pharmacy and your location. Ask the pharmacy for an estimated delivery time when you submit the prescription, or pick it up in person if you live near the pharmacy.

Yes - through a new consultation. Your original consultation closes once the prescription is issued, so adjustments (changing the concentration, base, or active ingredient) are handled by submitting a follow-up consultation through the same process as your original request. Returning patients move through faster - your clinician will have your prior intake on file. The pharmacy can usually re-compound with the adjustment within a few business days of the new prescription.

Follow the storage instructions on the prescription label. Most compounded creams are stored at room temperature, away from direct sunlight and heat. Some require refrigeration - the pharmacy will tell you if yours does. Do not freeze.

A 30 g tube typically lasts 2 to 3 months when used once daily on the face. Smaller treatment areas (just dark patches, for example) make a tube last longer. Larger areas (whole face plus neck) use it faster.

No. A compounded cream is prescribed specifically for your skin, your concern, and your medical history. The strength may be too strong or too weak for someone else, and they may have a contraindication that you do not. Sharing prescription medications is not safe.

Submit a renewal request through TeleTest. The clinician will review your progress, ask if anything has changed, and renew or adjust as appropriate. Renewals are usually faster than the initial consultation.

The clinician sends the prescription to the pharmacy of your choice in Canada. Many compounding pharmacies ship across Canada by courier, so you have options even if there is not a compounding pharmacy in your city.

No. Off-the-shelf prescription creams are pre-made at fixed concentrations. A compounded cream is custom-made to your clinician's specifications. Both can be effective; the compounded version gives more flexibility on strength, combinations, and base.

Sometimes. If an off-the-shelf product matches what you need closely enough, your clinician may recommend the switch (often as you transition to maintenance). Off-the-shelf products are usually easier to find and may have insurance coverage that compounded versions do not.

Compounded creams vary in texture and scent depending on the base and active ingredients. If the cream looks separated, has changed colour, or has an unusual rancid smell, contact your compounding pharmacy - it may have been stored incorrectly or expired. Otherwise, mild variation in texture and smell from product to product is normal.

Most regimens take 4 to 12 weeks for first visible change. Stubborn pigmentation takes 3 to 6 months or longer. Stick with the routine and check in with your clinician at the 8 to 12 week mark.

Yes, with planning. Most plans include a gentle cleanser, plain moisturizer, and daily sunscreen alongside the prescription cream. Avoid stacking multiple strong actives without checking with the clinician - some combinations cause irritation.

Stop the cream. Mild irritation usually settles with a short pause and a reduced frequency - you can submit a follow-up consultation through TeleTest to adjust the regimen. A more serious reaction (swelling, blistering, widespread rash) needs immediate in-person urgent care - and if you have trouble breathing, call 911.

• A skin lesion that is new, changing colour or shape, bleeding, or non-healing
• A patch that does not look symmetrical or matches none of the typical hyperpigmentation patterns
• Severe scarring or texture changes you want a hands-on assessment of
• Any reaction to a cream that is severe, blistering, or persistent

Not every pharmacy compounds. Compounding pharmacies are licensed to mix custom formulations and have the facilities to do so safely. You can:

• Ask any pharmacy whether they compound or can refer you to one nearby
• Ask your TeleTest clinician for compounding pharmacy options
• Search for "compounding pharmacy" in your city
• If you live in Ontario, use the TeleTest home-delivery partner pharmacy (Pace Pharmacy) - they compound and ship at pharmacy prices with no markup

Provide each pharmacy with the same prescription details (the active ingredients, concentrations, base, and tube size) and ask for a price. Costs can differ significantly between pharmacies for the same prescription. Two or three quotes is usually enough to find a fair price.

Many compounding pharmacies ship across Canada by courier. The clinician can suggest options that ship to your address. Off-the-shelf prescription products are also available for some concerns - the clinician can let you know whether your prescription can be filled at a regular pharmacy without compounding.

Most compounded cosmetic creams are not covered under provincial health plans and are self-pay. Some private drug plans cover compounded prescriptions in whole or in part. Ask your compounding pharmacy for a quote and check with your insurer.

Costs vary widely by pharmacy, the active ingredients, the concentrations, and the tube size. As a rough range, expect to pay more than a regular OTC product and less than a multi-session in-clinic procedure. Ask the pharmacy for a quote before filling.

• Dayal S, Sahu P, Dua R. Combination of alpha-hydroxy acid peel and topical brightening cream in melasma patients. J Cosmet Dermatol. 2017; 16(1):35-42. https://doi.org/10.1111/jocd.12260
• Kodali S, Guevara IL, Carrigan CR, et al. A prospective, randomized, split-face, controlled trial of beta-hydroxy peels in the treatment of melasma in Latin American women. J Am Acad Dermatol. 2010;63(6):1030-1035. https://doi.org/10.1016/j.jaad.2009.12.027
• Nasrollahi SA, Nematzadeh MS, Samadi A, et al. Evaluation of the safety and efficacy of a triple combination cream for melasma in Middle Eastern skin. Clin Cosmet Investig Dermatol. 2019;12:437-444. https://doi.org/10.2147/CCID.S202285
• Bertold C, Fontas E, Singh T, et al. Efficacy and safety of a novel triple combination cream 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
• Wang, R. F., Ko, D., Friedman, B. J., & Mohammad, T. F. (2023). Disorders of hyperpigmentation: Part I. Journal of the American Academy of Dermatology, 88(2), 271-288. https://doi.org/10.1016/j.jaad.2022.01.051
• Ko, D., Wang, R. F., Ozog, D., Lim, H. W., & Mohammad, T. F. (2023). Disorders of hyperpigmentation: Part II. Journal of the American Academy of Dermatology, 88(2), 291-320. https://doi.org/10.1016/j.jaad.2021.12.065