Integrating Compounded Skincare into Clinic and Salon Protocols

Personalisation has become a default promise in skincare marketing, yet many clinics still run into the same bottleneck once a patient’s skin stops improving. The difference between “tailored” retail routines and true personalisation is that one adjusts what is already on the shelf, while the other changes the formulation itself, including the vehicle, excipients, pH window and concentration, based on the patient’s presentation and tolerance. That is where compounding pharmacies such as Roseway Labs sit.

Founded in 2018 by Elizabeth Philp (CEO) and Miriam Martinez Callejas (Chief Clinical Pharmacist), Roseway Labs specialises in the compounding of personalised medicine and the supply of licensed and unlicensed medications, supporting clinicians across dermatology, allergy and immunology, women’s health, men’s health, endocrinology and functional medicine. For aesthetic clinics and medical-led salons, the commercial interest is obvious. If a prescriber can specify a preparation that is built around the patient’s barrier status and pigment risk, clinics can stop forcing skin into product ranges that were never designed for outliers, complex cases, or fluctuating endocrine profiles.

That opportunity comes with constraints. In the UK, unlicensed “specials” are supplied for individual patients against an order from an appropriate prescriber, and the clinical need must be determined by the prescriber responsible for the patient’s care. In practice, the winning model for beauty businesses is not “we will make our own creams”, but “we will prescribe and partner with a specialist pharmacy that compounds, quality-checks, and supplies patient-specific preparations”.

Who benefits from compounding, and when retail should be left alone

While over-the-counter skincare is effective for many, certain physiological profiles reach a therapeutic plateau with retail options. As Iram Husain, Product Development Pharmacist at Roseway Labs, explains, “specific conditions are most likely to experience significant advantages from a medical prescriber’s intervention”.

For barrier dysfunction, the difference is often less about adding more actives and more about removing unnecessary triggers while rebuilding the lipid architecture the skin actually needs. “Barrier Dysfunction (Rosacea, Eczema, Psoriasis): Many retail products for sensitive skin often contain ingredients like preservatives or fragrances that can trigger reactions,” Husain says. “Some products are too heavy for rosacea, trapping heat and making redness worse. Others don’t provide enough of the right skin-repairing fats for chronic eczema.” In these cases, personalisation is not a luxury. “Personalised skincare allows the formula to be matched to the skin’s needs, using gentle bases with the correct balance of skin-supporting lipids without the unnecessary ingredients that often cause flare-ups.”

Endocrine-linked skin shifts are another cohort that can look “stuck” when the routine is sound but the biology is moving. “Endocrine Shifts (PCOS, Menopause, Thyroid Dysfunction): Off-the-shelf skincare products cannot respond to the changes in sebum and pH balance resulting from hormonal fluctuations,” Husain explains. The clinical value of compounding here is responsiveness. “With compounding, a prescriber can adjust skincare over time as hormones change using light products for oily, acne-prone skin, and moving to richer creams when skin becomes dry and fragile later in life.”

Then there is the increasingly common “over-processed” skin presentation, where the patient has self-directed a strong active routine until their tolerance collapses. “Over-Processed Skin: Patients with acquired sensitivity from misuse of high-strength OTC actives often experience stinging even with basic brands due to hidden surfactants or alcohols,” says Husain. Compounding can be used as a reset, because “minimalist compounding allows for stripped-back preparations with zero fragrance or aggressive stabilisers to reset the skin microbiome.”

Pigmentary complexity, particularly in higher Fitzpatrick types, is an area where formulation restraint is often as important as the active choice. “Pigmentary Complexity (Melasma and PIH in High-Fitzpatrick types): Retail brighteners often rely on high-acidity L-Ascorbic Acid or aggressive exfoliants. In darker skin tones, this irritation can trigger paradoxical hyperpigmentation,” Husain says. A compounded approach can reduce that irritation load while maintaining clinical intent. “Compounding employs agents like Hydroquinone and Tranexamic Acid in precise, slow-release concentrations that address melanocytes without inducing inflammation.”

What clinics can measure, and what they can expect to retain

For clinics assessing whether compounded prescriptions belong in their protocols, measurable outcomes tend to appear in three areas: efficacy, adherence and retention. “Utilising personalised, compounded skincare ensures therapeutic precision, leading to measurable gains in three key areas,” Husain says.

The first is clinical efficacy, particularly where mass-market products introduce avoidable irritants and slow progress. “Clinical Efficacy: Personalisation mitigates the risk of adverse events by addressing the excipient burden found in mass-market products,” she explains. “Removing commercial preservatives and fragrances reduces contact dermatitis and treatment lag.” The practical consequence is earlier visible change in common indications. “This approach often leads to quicker visible improvements in acne, rosacea, or pigmentation, with measurable improvements in skin strength and hydration seen within two to three weeks.”

The second is adherence, which is frequently underestimated in medically led skincare because the protocol looks correct on paper. “Increased Patient Adherence: Treatments often fail due to cosmetic issues, such as products being too greasy or too dry,” says Husain. “Customised products allow prescribers to match the formulation to the patient’s skin and preference, leading to better adherence.”

The third is patient retention, especially when standard products have already failed and the patient is primed to disengage. “Enhanced Patient Retention: Clinics often lose patients when standard products fail,” Husain says. “With a compounded approach, a failed treatment is not a reason to lose a patient; it becomes data for fine-tuning the formula and understanding what works and doesn’t for the patient.”

The actives clinics most often tailor, and why the range matters

The strategic advantage of compounding is the ability to stay within the therapeutic window while controlling irritation and supporting long-term use. “Tailoring allows clinicians to stay within the therapeutic window,” says Husain, highlighting several actives that clinics regularly request at custom strengths.

For retinoids, titration is central. “Tretinoin (0.01% to 0.5%): Tailored to the patient’s retinization threshold,” she explains. “Starting low for Rosacea prevents the ‘peeling to the pink’ effect while maintaining regulation of cell turnover.”

Azelaic acid is another common request, partly because “retail products typically cap at 10%”. With compounding, “Azelaic Acid (4% to 20%): While retail products typically cap at 10%, compounding permits 20% concentrations, serving as a powerful anti-inflammatory for rosacea and PIH.”

Hyperpigmentation protocols often require structured dosing rather than a fixed percentage indefinitely. “Hydroquinone (0.8% to 10%): Compounding enables short-term high-dose therapy for persistent pigment, followed by a tapered dose to mitigate the risk of ochronosis.”

For inflammatory dermatoses, Husain notes how compounding can help manage potency and surface area risk. “Corticosteroids: Tailoring allows for dilution therapy, where a potent steroid is blended into a bespoke emollient to create a mid-strength formula suitable for larger body areas, reducing the risk of skin atrophy.”

Vehicles, penetration enhancers and the barrier first approach

For therapists and prescribers, vehicle choice is not a cosmetic afterthought. It is part of the clinical design, particularly when the barrier is compromised or pigment risk is high. “The selection of a vehicle and penetration enhancer (PE) depends on the integrity of the skin barrier and the target layer of the pathology,” Husain says.

On barrier status, she differentiates between protective bases and lighter textures that reduce congestion risk. “Barrier Status: When the skin barrier is badly damaged or irritated, water-free bases can protect the skin and reduce stinging. For oily or acne-prone skin, lighter water-based lotions and serums are preferred because they hydrate without blocking pores.”

On Fitzpatrick type, she flags formulation triggers that can backfire, especially in IV to VI. “Fitzpatrick Type: For high-Fitzpatrick types (IV–VI), highly acidic vehicles or high concentrations of ethanol are avoided to prevent micro-burns and rebound pigmentation.” Conversely, “for low-Fitzpatrick types (I–III), light creams or gels are preferred to prevent heat retention that exacerbates rosacea.”

Penetration enhancers are used selectively, not automatically. “PEs like Propylene Glycol or Ethanol are used to facilitate the passage of actives,” Husain says. “However, their use must be balanced; for example, Ethanol should be avoided in Rosacea, while Oleic Acid is better suited for dry pathologies where barrier repair is also needed.”

Stability, pH windows and why some combinations fail quietly

One of the least visible causes of poor outcomes is instability, particularly when multiple actives are combined without a workable shared pH. “Every active ingredient has a specific pH range where it is most stable and biologically active,” Husain says. “When combining ingredients, you must find a shared pH window.”

She points to common examples that clinics frequently attempt to layer. “Azelaic Acid pH ~ 4.0 - 5.0: It is stable in this range, but if the pH climbs too high, it becomes less effective.” Niacinamide can become actively irritating if it is forced into an overly acidic environment. “Niacinamide pH ~ 6.0: If you put Niacinamide in a very acidic environment (like pH < 4.0), it can undergo hydrolysis and convert into Nicotinic Acid, which causes intense skin flushing and irritation.” Retinoids have their own constraints. “Tretinoin pH ~ 5.0 - 6.0: Retinoids are notoriously challenging to formulate. They degrade rapidly outside of their narrow window.”

For combinations that frequently come up in acne, redness and texture protocols, labs aim for a practical compromise. “When combining Tretinoin, Azelaic Acid, and Niacinamide, labs target a pH of ~ 4.5 to 5.0,” Husain says. “This is the sweet spot where all three remain stable and active.”

Allergen avoidance and excipient control for reactive skin

In reactive skin, progress is often interrupted by trial-and-error product switching. A compounded approach makes it possible to keep the clinical direction while stripping out suspected triggers. “The Roseway Labs compounding approach replaces guesswork with precision,” Husain says. “While a patient’s typical response to a reaction from an OTC product is to throw the bottle away, a clinician using a compounding lab can simply adjust the formula to make it suit the patient’s skin needs.”

That begins with avoiding common irritants and controlling preservation. “We can eliminate triggers by ensuring products are 100% free of fragrance and essential oils.” She adds, “we can also minimise preservatives, as our products are made to order, and will have a shorter expiry compared to marketed products.” For barrier-challenged patients, excipient selection matters as much as the active. “We use emulsifiers that integrate into the skin rather than stripping it.” The operational advantage for clinics is flexibility. “Critically, we allow the prescriber to remove any suspected triggers without abandoning the entire treatment protocol.”

Step-up and step-down planning to build tolerance without losing results

Long-term outcomes depend on respecting tolerance thresholds and managing irritation proactively, particularly with retinoids, acids and pigment suppressors. “In clinical dermatology, the key to long-term barrier health is understanding and managing the skin’s tolerance threshold,” Husain says. “Compounding replaces a one-size-fits-all approach with formulas that can be fine-tuned over time using a dynamic titration model.”

For sensitive skin, that can look like controlled escalation. “For sensitive skin, a clinician can use a staircase approach to introduce Tretinoin at custom percentages to build tolerance.” For hyperpigmentation, it can mean structured de-escalation. “Conversely, when using Hydroquinone for concerns like pigmentation; it can also mean carefully reducing strength over time to maintain results while protecting the patient from systemic side effects.”