Targets: Localised neuropathic (nerve) pain, including diabetic neuropathy, post-shingles pain and chemotherapy-induced nerve pain.

Features and benefits: Amitriptyline is a tricyclic antidepressant, but in compounding it is most often used topically, as a cream at around 1% to 10%, and frequently in combination with ketamine, to treat localised nerve pain. Applied directly to the painful area, it can ease burning, shooting and tingling pain while keeping the drug largely out of your bloodstream. That avoids much of the drowsiness and dry mouth associated with the oral tablets, which makes a bespoke topical formulation a useful option if you cannot tolerate systemic nerve pain medications. Prescription only.

How it works: Applied to the skin, amitriptyline blocks voltage-gated sodium channels in the peripheral nerves. The mechanism is similar to that of local anaesthetics, and it quietens the overactive nerve signalling that produces neuropathic pain. Studies of topical formulations show minimal absorption into the bloodstream, which concentrates the effect where it is needed.

Precautions: Topical use is well tolerated by most people, and local skin irritation is the most common complaint. Taken systemically, amitriptyline can cause drowsiness and dry mouth, and at higher doses it can affect heart rhythm. It also interacts with a number of other medications, so your formula and dose are determined by your prescriber. Prescription only.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC7182372/

Targets: Dullness, uneven skin tone, hyperpigmentation, melasma, sun damage, fine lines and wrinkles, loss of firmness, environmental and free-radical damage.

Features and benefits: A topical serum or cream. L-ascorbic acid is the pure, active form of vitamin C and the most researched. Clinically useful formulations generally sit between 8% and 20%, because concentrations above 20% offer no added benefit and can cause more irritation. Vitamin C is available over the counter, but compounding lets us tailor the strength, the base and the supporting actives to your skin. It brightens dull skin, fades pigmentation, builds collagen for firmer skin, and provides antioxidant protection against UV and pollution damage. Vitamin C does not replace sunscreen, but layering it underneath your SPF in the morning meaningfully improves your overall photoprotection. It works synergistically with vitamin E, and it combines safely with tretinoin, with other antioxidants and with alpha hydroxy acids.

How it works: Ascorbic acid works in three ways at once. As a potent antioxidant, it neutralises the free radicals generated by UV exposure and pollution before they can damage skin cells and collagen. It is also an essential cofactor for the enzymes that build collagen, so it directly stimulates new collagen synthesis while helping to stabilise existing collagen fibres and slow their breakdown. Finally, it inhibits tyrosinase, the enzyme that drives melanin production, and that is what fades dark spots and evens out skin tone.

Precautions: Vitamin C is well tolerated and safe for long-term daily use, including in pregnancy, which is one reason it is such a good alternative for anyone who cannot use retinoids. Some people notice mild stinging, redness or dryness, particularly at higher concentrations or on sensitive skin, and a moisturiser usually settles this. Ascorbic acid is inherently unstable and oxidises on exposure to light and air, turning yellow or brown. A discoloured product has lost potency, so store yours in an airtight, opaque container away from light, and replace it if the colour changes. Oxidised product can also leave a temporary yellow staining on skin and clothing.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC5605218/

Targets: Acne, rosacea, redness, hyperpigmentation, melasma, uneven skin tone.

Features and benefits: This is a particular favourite for some of the Pharmacists here at The Melbourne Compounding Lab, for its affordability and its effectiveness. A naturally derived dicarboxylic acid, compounded as a cream or gel, commonly at 10% to 20% and higher when tailored. Azelaic acid is antibacterial, anti-inflammatory and brightening at the same time, which makes it useful when acne and rosacea occur together, and useful again for fading the pigmentation left behind. It is gentle and well tolerated. It is also one of the very few actives in this category generally considered acceptable during pregnancy, although you should always confirm this with your doctor first. Azelaic acid can be combined with other ingredients in a bespoke acne, rosacea or pigmentation formula.

How it works: Azelaic acid acts on several fronts at once. It is antimicrobial against C. acnes, the bacteria involved in acne. It normalises the way pore-lining cells shed, which prevents blockages forming. It calms inflammation and redness. It also inhibits tyrosinase to reduce excess pigment, so it addresses both the breakout itself and the mark it leaves behind.

Precautions: Azelaic acid is well tolerated by most people. Some notice mild tingling, itching or a warm sensation when they first start using it, and this usually settles. Introduce it gradually if your skin is sensitive. As with all active skincare, daily SPF is recommended. Azelaic acid is notorious for being gritty and clumping on the skin, to address this we've invested in the latest lab technology to micronise particle ointment size to produce a smooth and rich product.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC10339666/

Targets: Male pattern hair loss (androgenetic alopecia), female pattern hair-loss, hirsutism and PCOS.

Features and benefits: A prescription 5-alpha reductase inhibitor, taken orally at around 1mg, or increasingly applied as a compounded topical solution. Finasteride tackles the hormonal driver of male pattern baldness at its source, and along with minoxidil it is one of only two treatments with strong long-term evidence in this condition. It slows further loss, and for many men it promotes regrowth. A compounded topical version, often paired with minoxidil, delivers the drug to the scalp while substantially reducing the amount that reaches the rest of the body. This appeals to men who are concerned about systemic side effects. Its use in women is complex and is generally (but not exclusively) reserved for postmenopausal women. Topical and oral forms are used for women, this is certainly an area that needs thorough discussion with your G.P., dermatologist or endocrinologist.

How it works: Finasteride blocks the enzyme that converts testosterone into dihydrotestosterone, or DHT. DHT is the hormone that progressively shrinks genetically sensitive scalp follicles, a process known as miniaturisation. By lowering DHT levels, finasteride halts that process and gives the follicles a chance to recover.

Precautions: A minority of men experience sexual side effects such as reduced libido or erectile changes, and less commonly, changes in mood. Topical use lowers systemic exposure and may reduce this risk. Finasteride must not be used in pregnancy, and women who are or may become pregnant must not handle broken or crushed tablets, because it can cause abnormalities in a male foetus. Prescription only.

The data:https://pmc.ncbi.nlm.nih.gov/articles/PMC6609098/

Targets: Localised neuropathic pain, vulvodynia (chronic vulval pain), and other nerve-related pain conditions.

Features and benefits: Gabapentin is best known as an oral nerve pain and anticonvulsant medication, but it can be compounded into a topical cream, commonly at 2% to 6%, to treat localised neuropathic pain and conditions such as vulvodynia. Applied directly to the affected area, it targets the pain locally while avoiding the drowsiness, dizziness and swelling that often limit the oral form. A bespoke topical formulation therefore suits people who need nerve pain relief in one specific area without whole-body side effects. Prescription only.

How it works: Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels on nerve endings. This reduces the release of the excitatory neurotransmitters that amplify pain signals. Applied topically, it dampens that overactive signalling at the site of the pain itself.

Precautions: Topical gabapentin is well tolerated and has few systemic effects. The oral form can cause drowsiness, dizziness and fluid retention, and it should not be stopped abruptly. Your strength and regimen are set by your prescriber. Prescription only.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC6313270/

Targets: Eczema, dermatitis, allergic and irritant rashes, itching, insect bites, mild inflammatory skin conditions.

Features and benefits: A mild, low-potency topical corticosteroid available as a cream, ointment or lotion. Strengths of 0.5% to 1% can be bought over the counter for short-term use, while higher strengths and combination formulas are prescribed or compounded. Hydrocortisone settles redness and swelling quickly, and it interrupts the itch-scratch cycle that drives many skin flares. It can be compounded with other actives, such as an antifungal, actives that may inflame the skin or a moisturising base, so that one product does the work of several. As one of the gentlest steroids available, it suits more sensitive areas and short courses when used appropriately. Increasing strengths requires a prescription.

How it works: Hydrocortisone binds to glucocorticoid receptors inside skin cells and switches off the production of inflammatory chemical messengers. This dampens the local immune response responsible for the redness, heat, swelling and itch of a flare. It can also constrict blood vessels in the outer layers of skin causing a reduction in the release of Pro-inflammatory cytokines.

Precautions: Use it in short courses and apply it sparingly. Prolonged use can thin the skin, especially on the face, in skin folds, or on broken skin. It should not be applied to an untreated skin infection, because it can mask the infection and allow it to worsen. If a rash is not improving, see your doctor rather than continuing to treat it indefinitely.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC11407601/

Targets: Melasma, hyperpigmentation, dark spots, sun and age spots, post-inflammatory pigmentation (such as the marks left behind by acne), uneven skin tone.

Features and benefits: Topical cream, usually 2% to 4%, and higher when compounded. Hydroquinone remains the most established skin-lightening agent for stubborn pigmentation. It is often compounded into a triple combination alongside tretinoin and a mild corticosteroid (the modified Kligman formula), which improves results while reducing irritation. It fades melasma and dark patches that have not responded to gentler actives, and it evens out overall skin tone. Hydroquinone is used in cycles, meaning a few months of treatment followed by a rest period, to get the best result while protecting your skin. Visible improvement usually takes around five to seven weeks of consistent use, with fuller results appearing over several months. Always pair it with a broad-spectrum SPF 30+, because sun exposure will undo your progress.

How it works: Hydroquinone inhibits tyrosinase, the enzyme that pigment-producing skin cells (melanocytes) use to manufacture melanin. Melanin is the pigment responsible for dark spots. By slowing the production of new pigment while your natural cell turnover carries away the old, hydroquinone gradually lightens hyperpigmented areas back toward your natural tone.

Precautions: Redness, dryness and irritation are common, particularly in the early weeks of treatment. Prolonged, high-concentration or continuous use without rest cycles carries a rare risk of ochronosis, a bluish-grey darkening of the skin. For this reason hydroquinone is prescribed in supervised courses rather than used indefinitely. It is not recommended in pregnancy or while breastfeeding. Daily UV protection is essential. Higher strengths require a prescription.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC10723018/

Targets: Localised neuropathic pain, complex regional pain syndrome (CRPS), diabetic neuropathy.

Features and benefits: Ketamine is an NMDA receptor antagonist. In pain compounding it is used topically at low concentrations, commonly 0.5% to 2%, and often in combination with amitriptyline or other actives, to treat difficult localised nerve pain. Applied to the skin over the painful area, it can help calm the wound-up nerve signalling of neuropathic pain with minimal absorption into the bloodstream, avoiding the systemic effects of injected or oral ketamine. A bespoke topical formulation is therefore worth considering for nerve pain that has not responded to standard treatments. Ketamine is a controlled substance and is available on prescription only.

How it works: Ketamine blocks NMDA receptors, which play a central role in central sensitisation. This is the process by which nerves become hyper-responsive and amplify pain over time. Applied topically, ketamine acts on peripheral receptors at the site of the pain, and studies show little systemic absorption from properly formulated creams.

Precautions: Topical formulations are designed to minimise systemic absorption, so the dissociative effects of systemic ketamine are not expected. Local skin irritation is the main consideration. Ketamine is a controlled substance and prescription only, and your formulation is dispensed under strict controls.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC4040331/

Targets: Muscle and joint pain, osteoarthritis, sprains, strains, localised inflammation.

Features and benefits: Ketoprofen is a non-steroidal anti-inflammatory drug (NSAID). Compounded as a topical gel or cream, it delivers anti-inflammatory pain relief straight to a sore joint or muscle, and it is often included in bespoke combination pain creams. Because it is applied to the skin over the painful area, it concentrates the medication where it is needed while keeping blood levels low. That means far less risk of the stomach and gastrointestinal problems associated with oral anti-inflammatories, which makes it a practical option for targeted, ongoing musculoskeletal pain.

How it works: Ketoprofen inhibits the COX enzymes that produce prostaglandins, the chemical messengers behind inflammation, swelling and pain. Applied topically, it reduces prostaglandin production in the tissue directly beneath the application site.

Precautions: Local skin reactions can occur. Ketoprofen is strongly photosensitising, so keep treated skin covered and out of the sun. Avoid it if you are allergic to NSAIDs or have NSAID-sensitive asthma, and do not apply it to broken skin. Tell your pharmacist about any other anti-inflammatories you take.

The data:https://pmc.ncbi.nlm.nih.gov/articles/PMC6509095/

Targets: Insomnia, difficulty falling asleep, jet lag, shift-work sleep disruption, delayed sleep phase and other circadian rhythm disorders.

Features and benefits: Melatonin is the body's own sleep-timing hormone, and supplementing it can help you fall asleep faster and reset a disrupted body clock. Compounding allows for tailored doses and for immediate-release or modified-release formulations that match your particular sleep problem, whether that is a lower or slow-release dose for maintenance, or a precise paediatric dose. In Australia, melatonin generally requires a prescription, with a limited over-the-counter modified-release option available for adults over 55 or a short-course of immediate release melatonin intended for the use in jet lag. It is especially useful for circadian problems such as jet lag and delayed sleep phase.

How it works: The pineal gland naturally releases melatonin as darkness falls, signalling to your brain that it is time to sleep. Taken as a supplement at the right time of day, it reinforces or shifts that signal, shortening the time it takes you to fall asleep and helping to realign your sleep-wake cycle.

Precautions: Melatonin is well tolerated in the short term. Possible effects include daytime drowsiness, vivid dreams and headache. The timing of the dose makes a considerable difference to how well it works. Take care when combining it with other sedating medications, and speak to your prescriber about longer-term use.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC3656905/

Targets: Hair loss, male and female pattern hair loss (androgenetic alopecia), thinning hair.

Features and benefits: Available as a topical solution or foam at 2% to 5%, and increasingly as a compounded low-dose oral tablet on prescription. Minoxidil was originally a blood pressure medication, and its effect on hair growth was discovered as a side effect. It has since become a first-line hair loss treatment. It thickens the hairs you still have, prolongs the growth phase, and helps maintain and improve density over time. Compounding allows for custom concentrations, for combination with finasteride, or for a low-dose oral formulation if you find topicals messy or poorly absorbed.

How it works: Minoxidil extends the anagen phase, which is the active growth phase of the hair cycle, and it increases blood flow to the follicles. Thin, miniaturised hairs are encouraged to grow back thicker and longer. Its full mechanism is still not completely understood, although its ability to reawaken dormant follicles is well established.

Precautions: Topical minoxidil can irritate the scalp. Many people also see a temporary increase in shedding during the first few weeks, before regrowth begins, and this is expected. Unwanted hair growth elsewhere on the body can occur, and is more likely with the oral form. Oral minoxidil can cause fluid retention and cardiovascular effects, and is prescribed off-label with monitoring.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC12068484/

Targets: Chronic pain, fibromyalgia, and some autoimmune and inflammatory conditions when used at low doses.

Features and benefits: Naltrexone is an opioid receptor blocker used at high doses, around 50mg, in the treatment of dependence. At very low compounded doses, typically 0.5mg to 4.5mg, it behaves quite differently. Low-dose naltrexone, or LDN, is used off-label for chronic pain conditions such as fibromyalgia, where research suggests it can reduce pain with a reasonable safety profile. No low-dose commercial product exists, so LDN has to be individually compounded, and the dose is usually titrated upward gradually to suit each person. Prescription only.

How it works: At low doses, naltrexone briefly and partially blocks opioid receptors, which is thought to trigger a rebound increase in the body's own endorphins. It also appears to calm the immune cells of the nervous system, known as glial cells, by acting on TLR-4 signalling. This reduces the neuroinflammation that contributes to chronic pain.

Precautions: The most common side effects are vivid dreams, disturbed sleep and headaches, and these often settle with time. LDN must not be taken by anyone using opioid medication, because it can precipitate withdrawal. It is prescribed off-label, and while the research is promising, the evidence base is still developing. Prescription only.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC11450306/

Targets: Acne, blackheads, clogged pores, fine lines, wrinkles, photoaging, hyperpigmentation, skin texture.

Features and benefits: A prescription topical cream or gel, typically 0.025% to 0.1%. Tretinoin is the original retinoid and the most heavily researched of them, with strong evidence in both acne and skin ageing. It is more potent than over-the-counter retinoids such as adapalene, which is why it is available on prescription only. Tretinoin clears and prevents acne, softens fine lines, builds collagen, fades pigmentation and refines skin texture. Sunlight degrades it, so it is applied at night. We can compound it at a custom strength, or as part of a combination formula, to suit your skin and your tolerance.

How it works: Tretinoin binds directly to retinoic acid receptors in skin cells, switching on the gene expression that normalises how those cells mature and shed. This unclogs pores and speeds up healthy cell turnover. For ageing skin, tretinoin also stimulates new collagen formation while reducing the enzymes that break existing collagen down.

Precautions: Expect an adjustment period, sometimes called retinisation, with dryness, peeling and redness. Start slowly and build up your frequency over time. Tretinoin increases sun sensitivity, so use it at night and apply SPF 30+ during the day. It is contraindicated in pregnancy and for anyone trying to conceive. Avoid using it alongside harsh physical or chemical exfoliants.

The data: https://pmc.ncbi.nlm.nih.gov/articles/PMC9112391/