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Customized Skincare | Is this possible?

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Photo: Wix

In a nutshell: Can dermatologists prescribe customized topical treatments to patients, like the telehealth company Curology does?

The answer to this question is yes, with some caveats. There are multiple aspects to this question to address.

  1. Cost: Most prescription topicals I prescribe are generic and very well covered by insurance. Although there are definitely name-brand acne preps that can be very pricey, in my almost 17 years of practice I rarely if ever prescribe these unless there is some cost benefit to the patient. Generic copay costs are relatively low these days making these affordable through insurance while also contributing towards any potential deductibles to assist families further. Although I can prescribe customized therapeutics, these tend to be through compounding pharmacies making them a bit pricier but possible.

  2. Compounded side effects: Many acne medications notoriously work by drying or exfoliating the skin. By compounding ingredients there is a risk of excessive dryness or irritation making it difficult to discern which ingredient is the culprit. When products are used in isolation it is easier to figure this out.

  3. Altering concentrations of active ingredients to achieve optimal results. Although with a customized prep you can theoretically play with the recipe month the month, most of the time I have patients on a single maintenance ingredient making it unclear why a compounded product is always necessary. Also, most of the time I transition patients to option OTC maintenance routines that would be far less expensive than maintaining a prescription Rx.

  4. Altering routines temporarily. Many acne routines include the use of tretinoin. This is an essential component of many routines. However, if a patient is planning to get their eyebrows waxed, this ingredient needs to be held for a week while others do not. With a compounded product the patient will have no choice but to hold their whole routine and run the risk of flares.

More detailed info: Curology is a telederm subscription service. Its shtick is that it connects customers with healthcare providers who create customized (Rx) skincare regimens. Here's how it works: A new customer goes to the Curology site or app, fills out a survey about their skin concerns, and snaps a few photos of their face from different angles. Then, a dermatology nurse practitioner reviews the customer's survey/photos and develops a custom cream for them (called a "super bottle.") The cream will contain a blend of Rx-only ingredients. You get a new super bottle every two months, in addition to Curology cleanser and moisturizer. When I did Curology, my super bottle cream had azelaic acid (5%), tranexamic acid (2%), and niacinamide (4%), collectively intended to address redness, wrinkles, and firmness. I applied a thin layer of the cream all over my face nightly.

This highlights why these platforms are challenging.

A dermatology nurse practitioner does not formally exist. There is no recognized "board certification" for this title. These are nurse practitioners that may enjoy seeing the skin but their ability to tell the difference in photos between acne, rosacea, pityrosporum folliculitis, eosinophilic folliculitis, perioral dermatitis, seborrhea can lead to skincare routines that flare one condition while not addressing the actual cause.
I love that you revealed what was in your bottle. Azelaic acid is a prescription at the 15% concentration. Over the counter, The Ordinary and The Inkey List have the 10% concentration for about $7.90. This is misleading because azelaic acid is only Rx at certain concentrations- not the concentration you received. I have several patients who have received Curology bottles with extraordinarily low tretinoin concentrations. As a prescription, the entry-level strength for acne is 0.025%. Again very misleading with questionable efficacy. For the rest of your formulation: Tranexamic acid in the 2% concentration is also OTC- The inky list at Sephora has it for $14. Your niacinamide is in an extremely low concentration! OTC The Ordinary has the 10% Niacinamide for $5.90
Since COVID started Telehealth is widely available with actual Dermatologists that can prescribe truly effective medications or recommend OTC regimens that are affordable and effective.

I’m a huge fan of The Ordinary and The Inkey List. I describe these brands like a spice rack- they have all of these great ingredients at affordable prices that I can advise patients on how to combine.

Main question: I've read a lot of reviews of Curology, and it seems like some customers are using it instead of seeing a dermatologist in person -- because they have bad health insurance (or don't have insurance), or just because they find the telederm model faster and easier than going to a doctor. That's not how I used Curology, though. I've been seeing a dermatologist for years and never intended to stop. I tried Curology because I liked the idea of having only one topical cream, with the right percentage of each Rx ingredient already mixed in, instead of multiple prescriptions.

I think you can now just go to Sephora or Ulta’s website, buy each ingredient and use them together for a fraction of the price.

I'm wondering what dermatologists think about the concept of the Curology super bottle.

I’m not opposed to these ideas. I sincerely believe that acne can impact psychosocial health. By not providing a patient with timely predictable results, there can be mental health consequences that are simply not acceptable when there are better options.

Can I get something similar from a real-life dermatologist? By that, I mean could my doctor prescribe a custom topical formula, containing multiple Rx ingredients, that I could fill at my local pharmacy? If that is possible, why isn't it more common? Would it be prohibitively expensive, or only available through a compounding pharmacy?

This is possible, but not necessarily effective or practical. Especially when considering the ingredients that your “super bottle” had- there is simply no need for a compounding pharmacy to make this when any individual can buy the 3 ingredients and squeeze them into a bottle and mix. The actual active ingredients, when they need to be compounded for successful therapeutic results often already come as a pre-made generic or name brand that is routinely prescribed.

When I first found out about Curology, I was genuinely excited thinking that my patients could receive a prescription medication that I recommend through a monthly service. I thought it may perhaps increase compliance by receiving it routinely. When I found out what they were receiving, however, I realized very quickly this was not likely the case.


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