VX.4 | Daily Skin-Brightening Formula
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.
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).
Ascorbic Acid
Description: Potent antioxidant, promotes collagen synthesis, and reduces hyperpigmentation.
Mechanism of Action: Functions as a reducing agent, cofactor in collagen hydroxylation; inhibits tyrosinase activity to reduce melanin production.
Warning:
Pregnancy Category A: Considered safe topically in pregnancy and lactation.
Can cause mild stinging, redness, or irritation.
Drug Interactions: Topical vitamin C has minimal systemic interaction.
Usage Instructions:
Stop if severe burning, itching, or blistering.
Contact prescriber if inflammation/dermatitis develops.
Azelaic Acid
Description: A naturally occurring acid used to treat acne, rosacea, and hyperpigmentation.
Mechanism of Action: Possesses antimicrobial, anti-inflammatory, and tyrosinase-inhibiting properties.
Warnings:
Pregnancy Category B: No evidence of risk in humans.
Compatible with breastfeeding when used topically.
May cause skin irritation, burning, stinging, or dryness.
Hypopigmentation may occur in darker skin tones.
Avoid contact with eyes, mouth, and mucous membranes.
Tranexamic Acid
Description: An antifibrinolytic agent used topically for hyperpigmentation.
Mechanism of Action: Inhibits UV-induced plasmin activity, reducing melanocyte activation.
Warnings:
Limited data on pregnancy safety; use with caution.
Limited data on breastfeeding safety; use with caution.
Contraindicated in patients with active thromboembolic disorders.
Not recommended for patients with history of thrombosis or coagulopathy.
May cause mild irritation, redness, or dryness.
Drug Interactions:
Use caution with anticoagulants or medications affecting clotting.
Potential interaction with hormonal contraceptives.
Usage Instructions:
Discontinue if unusual side effects occur.
Alpha Arbutin
Description: A glycosylated hydroquinone derivative used for skin lightening.
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.
Generally milder than hydroquinone but may cause similar side effects.
Increased risk of sun sensitivity; daily SPF 30+ is recommended.
May cause mild irritation or redness in sensitive individuals.
Drug Interactions:
Avoid using with products that can destabilize alpha arbutin (highly acidic or alkaline products).
Use caution when combining with other skin-lightening agents.
Usage Instructions:
Store products containing alpha arbutin away from light and heat.
Product Usage Instructions
1. In the evening, wash your skin with a gentle cleanser, and dry it. After at least 15 minutes, apply one pump (a pea-size amount).
2. Start with 2-3 nights per week and, if your skin is tolerating the formula well, gradually increase to nightly use. For sensitive skin, try every other night at first. (And if you're transitioning from CX.1 Advanced Dark Spot Treatment, wait 3-5 days before beginning VX.4 to allow your skin time to adjust.)
3. Follow with a gentle moisturizer to maintain hydration and further support the skin barrier.
4. Always use broad-spectrum sunscreen with SPF 30+ during the day to protect results and prevent new pigmentation.
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.