Compounded dermatology preparations get marketed as “custom skincare,” which is a poor description of what they are and why prescribers order them. Compounding solves a specific, fairly short list of problems. When one of those problems is present, it is one practical option. When none of them is present, an FDA-approved product is the better choice, and a good pharmacy will say so.
This is a guide to which problems those are, what compounding cannot do, and the parts of the topic (vehicles, excipients, beyond-use dating) that actually determine whether a topical works. If the idea of a prescription being made to order is new to you, our explanation of how a compounding pharmacy differs from a retail pharmacy is the place to start.
Five reasons a dermatologist orders a compounded preparation
1. The strength isn't manufactured
Tretinoin is sold at 0.025%, 0.05% and 0.1%. A patient who cannot tolerate 0.05% but gets nothing from 0.025% has no commercial option in between. The same gap appears with hydrocortisone, where the jump from an over-the-counter 1% to a prescription 2.5% is the only step available. Compounding fills in the intermediate strengths, and it allows a prescriber to titrate down when irritation is the limiting factor rather than potency.
2. Several agents need to be in one vehicle
A regimen of three separate products applied at different times is a regimen many people abandon. Combining the agents into a single preparation is often the difference between a treatment that gets used and one that sits in a drawer. The best-known example in dermatology is the triple combination for melasma (hydroquinone with a retinoid and a corticosteroid, sometimes called the Kligman formula), which has been used in this form for decades.
Adherence is the honest justification here. It is not a claim that the combination is pharmacologically superior to the same agents applied separately.
3. The vehicle needs to match the site
This is the most underappreciated reason, and it is covered in its own section below. A corticosteroid that works well on a thick plaque on the elbow is the wrong choice for the scalp, the face, or a skin fold, not because the drug is wrong, but because the base is.
4. The patient reacts to an ingredient
Contact allergy to an excipient rather than to the active drug is common and frequently missed. Propylene glycol, a solvent in a great many topical products, was named Allergen of the Year by the American Contact Dermatitis Society in 2018. Formaldehyde-releasing preservatives, fragrance, lanolin, and benzyl alcohol are also well-documented sensitizers.
A patient with patch-test-confirmed sensitivity may have no commercial product they can use. Compounding the same active drug into a base free of that specific ingredient is a direct solution to a problem no manufacturer will solve for one person. If you have had patch testing, bring the results: the pharmacy needs the specific allergen names to build around them.
5. The commercial product is discontinued or unavailable
Products are withdrawn for commercial reasons that have nothing to do with whether they worked. When a preparation a patient has done well on leaves the market, compounding can reconstruct it.
What compounding does not do
An honest account has to include this list, because a great deal of marketing in this field implies otherwise.
- It does not make a drug more effective. Compounded tretinoin is tretinoin. The advantage, when there is one, comes from strength, vehicle, combination, or excipients, not from the compounding itself.
- Compounded preparations are not FDA-approved. The FDA has not evaluated them for safety, for effectiveness, or for manufacturing quality. That is true of every compounded preparation, including everything described on this page.
- Potency and stability are not verified batch by batch the way a manufactured product's are. Compounding pharmacies work to USP standards and to the formula record, but there is no premarket testing program behind an individual prescription.
- It usually is not covered by insurance. Compounded preparations are frequently excluded from pharmacy benefits outright. Ask for the cash price before assuming a copay.
- It cannot legally be a copy of an available product. Under section 503A of the Federal Food, Drug, and Cosmetic Act, a compounded drug may not be essentially a copy of a commercially available drug product. If a prescriber determines that a change (a different strength, the removal of an allergen) makes a significant difference for a particular patient, that is a different matter, and the reason belongs on the prescription.
None of this argues against compounding. It argues for using it where it answers a real problem, which is the whole of the case for it.
The vehicle matters as much as the drug
The base a drug is dispersed in determines how much of it reaches the skin, how it feels, whether the patient will keep using it, and, for corticosteroids, how potent the finished product is.
| Vehicle | What it is | Suits | Trade-offs |
|---|---|---|---|
| Ointment | Mostly oil, little or no water | Thick, scaly or lichenified plaques; very dry skin | Greasy; poor on scalp and in folds |
| Cream | Oil-and-water emulsion | General use on most body sites | Requires preservatives; common contact allergens |
| Lotion | Higher water content, pourable | Large areas; hair-bearing skin | Less emollient; can sting on broken skin |
| Gel | Semisolid, often alcohol- or water-based | Oily and acne-prone skin; scalp | Alcohol content can sting and dry |
| Solution | Liquid | Scalp and other hair-bearing areas | Drying; stings on fissured skin |
| Foam | Quick-break preparation | Scalp and large areas; good adherence | More expensive to produce |
| Paste | Ointment with powder suspended in it | Protecting and absorbing, as in perianal use | Stiff and difficult to remove |
The consequence people miss: the same corticosteroid molecule is more potent in an ointment than in a cream. Occlusion increases penetration. This is why topical steroid potency classes are assigned to finished products rather than to molecules, and why a formulary lists the same drug in two different classes depending on its base. The seven-class potency chart on our fluocinonide and triamcinolone pages sets this out in full.
Site matters for the same reason. Facial skin, eyelids, and skin folds are thin and absorb far more than the palms or soles; a potency appropriate for a plaque on the shin can cause atrophy on the face. Matching potency and vehicle to the site is most of the skill in prescribing a topical steroid.
Preparations commonly compounded in dermatology
Everything in this section is compounded to a prescriber's order and is not FDA-approved. The searchable catalog of compounded preparations lists what else is prepared here.
Acne
Combination gels bring a retinoid, an antibiotic, and other agents into one nightly application. Our tretinoin, niacinamide and hyaluronic acid gel is one example; the acne page covers the range.
Two practical notes. Clindamycin and benzoyl peroxide work by different mechanisms (clindamycin is an antibiotic, benzoyl peroxide is antibacterial and mildly keratolytic), and benzoyl peroxide is included in combinations partly because it reduces the development of antibiotic resistance. And higher is not better with benzoyl peroxide: strengths above roughly 10% have not been shown to work better than 2.5% to 5%, while irritation rises steadily with concentration. Independent testing reported in 2024 also raised questions about benzene forming in benzoyl peroxide products stored at high temperatures, prompting FDA testing and a small number of recalls; the practical advice is to store these products at room temperature rather than in a hot car or a steamy bathroom.
Melasma and hyperpigmentation
See our melasma and dark spots and hydroquinone blends pages. The regulatory position here is worth knowing before you start: the CARES Act removed over-the-counter hydroquinone from the market effective September 23, 2020, and prescription hydroquinone products in the United States are not FDA-approved. Prolonged use carries a risk of exogenous ochronosis, a paradoxical blue-black discoloration that is difficult to reverse, which is why these preparations are normally used in defined courses rather than indefinitely, and why sun protection is part of the treatment rather than an afterthought.
Eczema and inflammatory dermatoses
Topical corticosteroids in a strength and base matched to the site, and steroid-sparing options such as compounded tacrolimus for areas where long-term steroid use is a problem: the face, eyelids, and skin folds in particular. Triamcinolone and fluocinonide sit at opposite ends of the potency range and illustrate how much the choice matters.
Rosacea
See rosacea and facial redness. Vehicle choice carries extra weight here, since rosacea-prone skin is often intolerant of alcohol, propylene glycol, and fragrance, an instance where the excipient question above is the whole problem.
Fungal and nail conditions
Ciclopirox in various strengths and vehicles. Nail infections are slow: a toenail takes roughly nine to twelve months to grow out, so judging a topical antifungal before then is judging it early.
Combination antimicrobial and anti-inflammatory creams
Preparations such as our mupirocin, betamethasone and miconazole cream are used where infection and inflammation coexist and the diagnosis is mixed or uncertain, the same combination described in our article on the all-purpose nipple ointment. These are for defined courses, not maintenance: prolonged use of a topical antibiotic promotes resistance, and prolonged use of a steroid on an untreated fungal infection makes it worse and harder to recognize.
Hair loss
See hair loss and our minoxidil and finasteride scalp preparations. Two safety points belong with any discussion of these:
- Topical finasteride is not FDA-approved (only oral finasteride is), and it is absorbed systemically rather than acting only where it is applied.
- Finasteride is contraindicated in pregnancy and in women who may become pregnant. It can cause abnormalities of the external genitalia in a male fetus. Women who are or may become pregnant should not use it and should not handle a leaking container or broken tablets. This applies to the topical form.
Minoxidil works for some people and not others, takes three to six months to show anything, and stops working when it is stopped: the hair gained is lost over the following months. That is worth knowing before starting rather than after, and our guide to compounded minoxidil solutions goes through the strengths and scalp vehicles in more detail.
Procedural anesthesia
Compounded topical anesthetics such as BLT cream are used before dermatologic procedures, a use our article on BLT topicals for dermatologic procedures covers in more depth. FDA issued a warning on March 26, 2024 about compounded topical anesthetics, and the risks it described are real: applying too much, to too large an area, or under occlusion can produce systemic absorption at dangerous levels. Follow the amount and timing on the label, apply a thin layer, and do not wrap the area unless your prescriber specifically told you to.
Molluscum and warts
Cantharidin is a long-standing example of the 503A question in action. It was compounded for decades without an approved product existing; an FDA-approved cantharidin product for molluscum has since become available, which changes the analysis for that indication. This is exactly the situation where the prescriber's reason for wanting a compounded preparation, rather than the approved one, needs to be on the prescription.
A correction worth making about scalp conditions
Seborrheic dermatitis and dandruff are not caused by an accumulation of dead cells that needs to be removed, and vitamins and minerals do not treat them. The condition is associated with Malassezia, a yeast that is part of normal skin flora, and with the skin's inflammatory response to it. Treatment is antifungal (ketoconazole, ciclopirox), often with a keratolytic such as salicylic acid to lift scale, and a topical corticosteroid for flares. Compounding is useful here mainly for getting those agents into a solution or foam that can actually be applied to a hair-bearing scalp, which is a vehicle problem rather than a formulation-secret one.
Beyond-use dates: why compounded products expire quickly
A compounded preparation carries a beyond-use date, not a manufacturer's expiration date. The distinction is real: an expiration date rests on stability testing of that specific product, while a beyond-use date is a conservative limit set by standards and by the pharmacist's judgment.
USP General Chapter <795> sets default limits for non-sterile compounded preparations. Water is the variable that matters most, because it supports microbial growth: non-aqueous preparations get substantially longer dating than water-containing ones. Preservatives extend it; the actual date assigned may be shorter than the default if an ingredient's stability calls for it.
Practical implications: buy the quantity you will use within the dating, store it as labeled, don't decant it into another container, and don't keep a tube past its date on the assumption that a drug lasts as long as a manufactured one would.
Questions people ask
Is a compounded topical stronger than what I can buy?
It can be made at a strength that isn't sold commercially, which is not the same as being stronger in effect. For several agents (benzoyl peroxide is the clearest case), higher concentrations bring more irritation without more benefit.
Are compounded dermatology preparations FDA-approved?
No. FDA has not evaluated them for safety, effectiveness, or manufacturing quality. This is a factual statement about the regulatory status, and it applies to all compounded preparations.
Do I need a prescription?
Yes. Compounded preparations are prescription medications, dispensed for a named patient on a prescriber's order.
Why did my dermatologist choose a cream instead of an ointment?
Usually the site, and whether you will actually use it. Ointments penetrate better and are more potent for the same steroid, but they are greasy and poorly suited to the face, the scalp, or skin folds. A treatment that gets applied beats a more potent one that doesn't.
I react to every moisturizer I try. Can compounding help?
Possibly. Leaving out an ingredient you react to is one of the common reasons a prescriber orders a compounded preparation. If patch testing has identified a specific allergen, the active drug can be compounded into a base that omits it. Bring the patch test results; the specific allergen names are what the pharmacy works from.
Can you copy a brand-name product that costs too much?
Not simply because of price. Section 503A does not permit compounding a drug that is essentially a copy of a commercially available product. If your prescriber determines that a change makes a significant difference for you, that reason goes on the prescription and the analysis is different.
How long until I know whether it is working?
It depends on the condition, and the honest answers are longer than people expect. Acne is usually judged at eight to twelve weeks. Melasma takes months and relapses with sun exposure. A toenail needs nine to twelve months to grow out, the timeline our guide to compounded treatments for nail fungus works through. Minoxidil needs three to six months.
Will my insurance cover it?
Frequently not. Compounded preparations are often excluded from pharmacy benefits. Ask for the cash price up front. Our frequently asked questions cover payment and how to send a prescription.
Why does my compounded cream expire so much sooner than a store-bought one?
Because it carries a beyond-use date set conservatively under USP <795>, rather than an expiration date supported by stability testing on that specific commercial formulation. Water-containing preparations get the shortest dating.
Can I use a compounded steroid cream on my face?
Only if it was prescribed for your face. Facial skin absorbs far more than skin on the trunk or limbs, and potent steroids can cause thinning, telangiectasia, and steroid-induced rosacea there. Do not move a preparation from one body site to another on your own.
Getting started
Start with the prescriber, not the pharmacy. A compounded preparation requires a prescription and, more importantly, a diagnosis: several of the conditions above look alike and are treated in opposite directions, and a topical steroid applied to an undiagnosed fungal infection makes it worse.
Useful things to bring to that appointment: what you have already tried and how your skin responded, any patch testing results, and any product that caused a reaction. If cost or an ingredient sensitivity is the reason a standard product hasn't worked, say so directly: those are the specifics that determine whether compounding is the right answer.
Bayview Pharmacy compounds the preparations described here to a prescriber's order, and our pharmacists are available to talk through strength, vehicle, and excipient questions with you or with your prescriber. More on our dermatology and skin page and in dermatology services.
This article is for general information and is not medical advice. Compounded preparations are not FDA-approved. Discuss your own situation with a licensed healthcare provider.
Frequently asked questions
How strong is fluocinonide compared with other steroid creams?
Topical steroids are grouped into seven potency classes, class I being the strongest and class VII the mildest. Fluocinonide 0.05% sits in class II (high potency) and the 0.1% cream in class I (superpotent). For comparison, triamcinolone acetonide 0.1% is class IV and over-the-counter hydrocortisone 1% is class VII — so fluocinonide is several steps up from anything sold without a prescription. The base matters too: the same steroid is generally more potent in an ointment than in a cream or lotion. A stronger class is not automatically a better choice; your prescriber selects the agent and strength.
Is triamcinolone stronger than hydrocortisone?
Yes, considerably. Over-the-counter hydrocortisone 1% is class VII, the mildest class. Triamcinolone acetonide 0.1% is class IV, several steps up, and it is prescription-only for that reason. That difference is why triamcinolone is used for conditions that have not settled with an over-the-counter cream, and also why it is used on a defined area for a defined course rather than indefinitely.
What is the difference between triamcinolone 0.025%, 0.1%, and 0.5%?
They are the same medicine at three concentrations, and they fall into three different potency classes. The 0.025% (class V) is the mildest and is used for larger areas, thinner skin, and step-down courses. The 0.1% (class IV) is the everyday strength for eczema, psoriasis, and dermatitis on the body and limbs. The 0.5% (class III) is reserved for thick, stubborn plaques on places like the hands, feet, elbows, and knees. Higher is not automatically better: more steroid on thin or inflamed skin also means more absorption and more risk of thinning. Your prescriber picks the strength.
Can tacrolimus be used on the face or eyelids?
Being steroid-sparing is the reason prescribers consider it there. Tacrolimus does not thin the skin the way long-term topical corticosteroids can, so it is often chosen for delicate areas such as the face, eyelids, skin folds, and the ear canal. Use it only on the areas your prescriber specifies, protect treated skin from the sun, and do not cover the area with bandages or wraps unless you are told to, since covering increases absorption.
How is this different from a steroid?
Tacrolimus is a calcineurin inhibitor, not a corticosteroid. It quiets the immune activity driving inflammation in the area where it is applied, and it does not thin the skin the way long-term topical steroids can. That is why prescribers reach for it on delicate places such as the face, eyelids, skin folds, and the ear canal, and for longer stretches of treatment.
Is hydroquinone banned in the US?
No. Hydroquinone is not banned — it moved to prescription-only. One prescription combination product containing hydroquinone holds FDA approval, for the short-term treatment of dark spots associated with moderate-to-severe melasma, and other strengths and blends are prepared by compounding pharmacies against an individual prescription. What is no longer permitted is selling hydroquinone over the counter without FDA approval. Some other countries have restricted it further, which is where the “banned” idea usually comes from.
What strength of hydroquinone needs a prescription?
All of them. There is no legal over-the-counter strength in the United States any more, so 2% requires a prescription just as 4% or 12% does. Compounded blends are commonly prepared between 4% and 12%, often alongside other actives, and the strength is chosen by your prescriber for your skin and your condition. Higher is not automatically better — stronger blends are more likely to irritate, and irritation itself can worsen pigmentation.
What is ochronosis, and how do I avoid it?
Exogenous ochronosis is a blue-black or gray-blue darkening of skin treated with hydroquinone, and it can be permanent. Risk rises with prolonged use, higher concentrations, and in people with darker skin tones. Avoid it by using the blend only for the cycle your prescriber sets, applying it only where directed, and stopping and contacting your prescriber at the first sign that treated skin is darkening rather than lightening.
Is compounded cantharidin FDA-approved?
No. A separate proprietary cantharidin product is FDA-approved for molluscum, but the compounded preparations Bayview makes are not FDA-approved. They are prepared by a licensed pharmacy pursuant to a prescription.
Why compound it when the tubes and lacquer are manufactured?
The manufactured products are one strength in each form. A prescriber may want a 6% cream or gel for a stubborn or widespread skin infection, a 1.5% shampoo, a solution for the feet and the skin around the nails, a lacquer in a vehicle the manufactured one does not offer, or a size the tubes do not come in. A higher strength is not known to work better or faster; it is your prescriber's call. When a manufactured product fits the order, Bayview dispenses the manufactured product.
What is minoxidil, and why is it in every formula?
Minoxidil is the shared base. It helps prolong the hair's active growth phase and support blood flow to the scalp, which can slow loss and support regrowth for some people. Other actives are added based on patient and severity.
Why can't women use the men's formulas?
Men's formulas contain finasteride or dutasteride, which women who are or may become pregnant should not use or even handle, because they can harm a developing baby. Women have their own formulas.
Can I wrap or cover the area after applying it?
Not unless your provider specifically tells you to. The FDA advises against wrapping skin treated with topical pain relief products in plastic wrap or any other dressing, because covering the area increases how much anesthetic passes into the bloodstream and raises the chance of serious side effects such as irregular heartbeat, seizures, and breathing difficulties. Occlusion is sometimes used deliberately under clinical direction; it is not something to do on your own. The same goes for applying heavily over a large area or to broken or irritated skin.
What's the difference between treating the bumps and treating the redness?
They're different jobs. Metronidazole, ivermectin, and azelaic acid work gradually on the acne-like bumps and inflammation. Brimonidine works on the background redness itself by temporarily narrowing the small blood vessels in the skin, it acts within hours but wears off each day. Some formulas combine both approaches in one cream.
What Bayview compounds for this
Important: Compounded medications are prepared to a prescriber's order for an individual patient. They are not FDA-approved, and the FDA has not evaluated them for safety, effectiveness, or manufacturing quality. This article is educational and is not a substitute for advice from your prescriber or pharmacist.
This preparation contains a controlled substance. Controlled-substance prescriptions carry refill limits, must be e-prescribed, and can only be shipped to states where Bayview holds the required licensure.
Uses discussed here may be off-label, meaning they are not part of any FDA-approved labeling. Off-label use is a decision for you and your prescriber, based on the available evidence.
Veterinary preparations are compounded to a veterinarian's order for a specific animal and are not FDA-approved animal drugs. Never give a compounded human medication to an animal without veterinary direction.
Compounded prescriptions are paid for directly rather than billed through insurance. Most are HSA/FSA-eligible, and many patients submit the receipt to their plan for possible reimbursement. Pricing depends on the strength, dose form and quantity your prescriber orders. Read more about cost and insurance.
Pricing for the dermatology preparations described here depends on the drug, the strength, the base and the quantity: the tretinoin, niacinamide and hyaluronic acid gel starts at $70, compounded fluocinonide at $98, compounded tacrolimus at $122, hydroquinone brightening blends at $149 and triamcinolone at $171. Compounded preparations are not FDA-approved and are frequently excluded from pharmacy benefits, so they are normally paid for directly rather than billed through insurance. Ask for the cash price before you order.
Bayview Pharmacy is a compounding pharmacy in Warwick, Rhode Island, licensed to fill and ship compounded prescriptions for patients in Rhode Island, Massachusetts, Connecticut, New Jersey, New Hampshire, Florida, Maine and Pennsylvania. Prescriptions for New York patients are filled on a limited basis, and controlled substances are not shipped to New York addresses. See every state we ship to.
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