CX.1 | Advanced Dark Spot Treatment
The information below on the primary and secondary active ingredients that we have considered for your personalized formulation is for educational purposes only, and should not be considered a substitute for counseling from the pharmacy or the prescribing physician.
Note that not all ingredients listed here are used in all custom formulations, and others may be used that are not listed here.
Active Ingredients
Tretinoin
Description: A prescription-strength retinoid (vitamin A derivative) used for anti-aging and acne treatment.
Mechanism of Action: Normalizes keratinization, increases cell turnover, and stimulates collagen production.
Warnings:
Pregnancy Category X: Contraindicated during pregnancy due to risk of severe birth defects.
Contraindicated during breastfeeding.
Causes increased sensitivity to sunlight; daily broad-spectrum SPF 30+ is mandatory.
May cause skin irritation, redness, peeling, and dryness, especially during initial weeks of use.
Avoid waxing, depilatory creams, and harsh exfoliants while using tretinoin.
Discontinue use 1-2 weeks before chemical peels or laser treatments.
Drug Interactions:
Do not use with benzoyl peroxide, as it may deactivate tretinoin.
Use caution with other potentially irritating topicals (AHAs, BHAs, sulfur, alcohol).
May increase absorption of other topical medications.
Usage Instructions:
Avoid application to eyes, mouth, angles of nose, and mucous membranes.
Hydroquinone
Description: A skin-lightening agent used to treat hyperpigmentation.
Mechanism of Action: Inhibits tyrosinase, reducing melanin production in the skin.
Warnings:
Pregnancy Category C: Use only if potential benefit justifies potential risk to fetus.
Not recommended during breastfeeding.
Risk of exogenous ochronosis (bluish-black pigmentation) with prolonged use.
May cause skin irritation, redness, dryness, or contact dermatitis.
Increased risk of hyperpigmentation with sun exposure; daily SPF 30+ is mandatory.
Not recommended for continuous use beyond 3 months without dermatologist supervision.
Discontinue if irritation, darkening, or other adverse reactions occur.
Drug Interactions:
Do not use with benzoyl peroxide, hydrogen peroxide, or other peroxide products.
May stain skin if used with resorcinol.
Usage Instructions:
Perform a patch test before full application.
Fluocinolone Acetonide
Description: A synthetic corticosteroid used topically to reduce inflammation and itching.
Mechanism of Action: Binds to glucocorticoid receptors, inhibiting inflammatory mediators and reducing inflammation.
Warnings:
Pregnancy Category C: Use only if potential benefit justifies potential risk to fetus.
Use caution during breastfeeding; avoid application to the breast area.
Risk of hypothalamic-pituitary-adrenal (HPA) axis suppression with prolonged use or application over large areas.
May cause skin atrophy, telangiectasia, striae, and acneiform eruptions with prolonged use.
Increased risk of glaucoma and cataracts with application near eyes.
Not recommended for continuous long-term use without dermatologist supervision.
Contraindicated in patients with viral skin infections (herpes, varicella).
May mask or worsen fungal infections.
Drug Interactions:
May increase risk of systemic effects when used with other corticosteroids.
Use caution with medications that inhibit CYP3A4 enzymes.
Usage Instructions:
Do not use occlusive dressings unless specifically directed.
Gradually taper use when discontinuing after prolonged therapy (more than 3 months of continuous daily use is considered prolonged therapy).
Niacinamide
Description: A water-soluble form of vitamin B3 used for its anti-inflammatory, antioxidant, and barrier-restoring properties.
Mechanism of Action: Improves epidermal barrier by enhancing ceramide and fatty acid synthesis; reduces inflammation via inhibition of NF-κB; decreases hyperpigmentation by slowing melanosome transfer.
Warnings:
Pregnancy Category A: Considered safe in pregnancy and lactation at typical topical concentrations.
May cause mild redness or irritation in sensitive skin.
Drug Interaction: Topical use has minimal systemic interaction.
Usage Instructions:
Discontinue if persistent redness, burning, or rash develops.
Contact prescriber if irritation worsens or skin barrier is compromised (i.e., eczema flare, open wounds).
Kojic Acid
Description: A fungal metabolite used for skin lightening and hyperpigmentation.
Mechanism of Action: Inhibits tyrosinase activity, reducing melanin production.
Warnings:
Limited data on pregnancy safety; use with caution.
Limited data on breastfeeding safety; use with caution.
May cause contact dermatitis or sensitization with prolonged use.
Increased risk of sun sensitivity; daily SPF 30+ is recommended.
Not recommended for continuous long-term use without breaks.
Drug Interactions:
Generally well-tolerated with other topical medications.
Use caution when combining with other potentially sensitizing ingredients.
Usage Instructions:
Perform a patch test before full application.
Discontinue if irritation or allergic reaction occurs.
Product Usage Instructions
1. In the evening, wash your skin with a gentle cleanser, and dry it. After at least 15 minutes, apply a single pea-size dollop to your finger. Rub this onto areas of discoloration only. Follow with moisturizer.
2. Start slowly: Begin with 2-3 nights per week, gradually increasing to nightly as tolerated.
3. Always use a broad-spectrum SPF 30+ sunscreen during the day, as brightening agents increase sun sensitivity. Sunscreens including iron oxides help reduce hyperpigmentation from ultraviolet, infrared, and visible light.
4. Use for 8-12 weeks as an intensive treatment. (Do not use hydroquinone for more than 12 weeks at a time. You may start treatment again after a break of at least 12 weeks.)
5. After 8-12 weeks, transition to VX.4 Daily Skin-Brightening Formula to prevent pigmentation from returning and support ongoing skin health.
General Warnings and Precautions
1. Patch Testing: Before using any new prescription topical product, perform a patch test on a small area of skin to check for adverse reactions.
2. Sun Protection: Many prescription topicals increase sun sensitivity. Daily use of broad-spectrum SPF 30+ is essential, along with sun-protective measures (hats, shade, protective clothing).
3. Pregnancy and Breastfeeding: Consult healthcare provider before using any prescription topicals during pregnancy or breastfeeding.
4. Skin Barrier: Discontinue use if signs of excessive irritation, persistent redness, or compromised skin barrier occur.
5. Medication Interactions: Inform all healthcare providers about all medications (topical and systemic) being used to avoid potential interactions.
6. Storage: Store all prescription topicals according to specific instructions, generally in a cool, dry place away from direct sunlight.
7. Expiration: Do not use products beyond their expiration date, as efficacy may decrease and irritation potential may increase.
8. Application Order: Follow specific instructions for the order of application when using multiple prescription products.
9. Hand Washing: Wash hands thoroughly after applying prescription topicals to avoid transfer to unintended areas.
10. Keep Out of Reach of Children: Store all prescription products securely away from children and pets.