Flawless

• Hydrates and soothes the skin
• Helps balance oil production and limits pore congestion
• May calm breakouts linked to hormone fluctuations^3,6
• May target unwanted facial hair caused by hormonal changes⁵
• Supports smooth-looking skin tone and texture over time⁶
• May help promote skin elasticity and firmness⁷

Possible Side Effects

• Stinging, burning, or itching⁶
• Redness, dryness, peeling, or mild irritation where the cream is applied^3,6
• Rare allergic reactions such as: hives, facial or throat swelling, or trouble breathing, which needs immediate medical attention

Warnings & Precautions

• Use exactly as the prescriber directs; applying more than recommended will not speed up changes in the skin and may increase irritation
• Speak with your provider before introducing other strong topical products, like retinoids or exfoliating acids. Introducing other active ingredients at once may increase irritation
• Individuals with sensitive skin who are experiencing irritation may want to reduce application frequency and consult a dermatologist for personalized advice
• Avoid contact with the eyes, lips, and inner nose

Contraindications

• Known allergy or sensitivity to azelaic acid, metformin, progesterone, spironolactone, or any other ingredient in this cream
• Pregnancy, or trying to become pregnant, without explicit guidance from your provider
• Breastfeeding, without explicit guidance from your provider
• Hormone-sensitive conditions, such as certain cancers, without explicit guidance from your provider

Drug Interactions

Topical application of these medications often has limited systemic absorption; there is limited evidence to support drug interactions.

• ACE inhibitors or ARBs (e.g., lisinopril, losartan): combined with spironolactone, these may raise potassium levels in the body
• NSAIDs (e.g., ibuprofen, naproxen): these may lessen some of spironolactone's effects and add to potassium-related risk
• Potassium supplements or salt substitutes containing potassium: combining these with spironolactone may push potassium levels higher than intended
• Other topical acne products, such as retinoids or benzoyl peroxide. Using several active ingredients on the same skin can increase irritation.

Handling Requirements

• Keep away from children and pets

Spironolactone and progesterone are incorporated for their anti-androgen properties. Spironolactone possesses anti-androgenic effects and a good tolerability profile.^4,5 Androgen hormones bind to specific receptors on skin oil glands, signaling the glands to promote oil production. Spironolactone blocks local androgen receptors in the skin, which may help limit the signal at the source.^4,5 This signal limitation slows down oil production from sebaceous gland potentially targeting pore congestion and inflammation. Progesterone is referenced in clinical literature as counteracting the effects of androgens; progesterone can help restore hormonal balance in the skin, targeting the production of excess oil and helping to control both blemishes and unwanted hair growth. It has also been shown to promote skin elasticity and skin firmness.⁶

Metformin’s usual role is supporting the body’s sensitivity to insulin. In some hormone-related skin and hair concerns, insulin resistance and androgen activity are closely connected; supporting one may help support the other.^1,2 When applied topically instead of orally, metformin may exert local effects on the skin by limiting androgen levels and promoting hormonal balance.^1,2

Azelaic acid targets multiple contributing factors in skin blemishes and has been referenced in clinical literature to be well tolerated. It can help calm inflammation, may help limit the growth of blemish-related microbial presence, and appears to help the skin shed dead cells evenly, so pores are less likely to become congested.⁶ It's also known for its gentle effect on skin tone, which may help soften the appearance of marks left behind after breakouts.⁶ By combining ingredients that may help balance hormones, limit unwanted hair growth, and manage blemishes, Flawless may help support overall complexion. This compounded formula is designed to help manage contributing factors related to unwanted facial hair and blemishes while promoting clear, healthy-looking skin.

Q: Why do hormonal blemishes or extra hair growth happen in the first place?

A: There are many reasons linked to hormonal blemishes or extra facial hair growth. However, they are often connected to androgens, hormones that every person makes, just in different amounts. Some hormone-related conditions may involve higher androgen activity, or skin that’s more sensitive to the androgens already there. This may present as breakouts along the jaw and chin, or extra hair growth in areas like the chin or upper lip. Every patient is different, and your provider may help you understand the underlying cause of skin blemishes and unwanted facial hair growth.

Q: Why does Flawless come as a cream?

A: Applying it directly to the skin lets the ingredients focus on affected areas you and your provider are trying to manage. Topical medications are often strong options for local skin concerns, as the specific ingredients used within them may have limited systemic absorption, which may contribute to overall tolerability.

Q: Can I use Flawless if I’m also taking oral spironolactone or metformin?

A: Patients may use topical and oral options together as part of a comprehensive plan developed by their health care provider. Flawless already contains spironolactone and metformin; it’s important to tell your provider about any oral versions to verify there are no interactions or excessive exposure.

Q: Can Flawless help with the underlying hormone-related condition itself, or just the skin and hair changes?

A: Flawless is applied to the skin and is designed to focus on the visible skin and hair concerns some people connect to hormone-related conditions. It works locally, rather than acting on the underlying condition throughout the body.

Q: Can I keep using my regular skincare and makeup with this cream?

A: It's recommended to bring in new exfoliants, retinoids, or other strong active ingredients slowly, since combining several strong products at once may increase dryness or irritation. Flawless is applied prior to other skincare products and should be allowed to absorb fully into the skin prior to applying other agents. Let your prescriber know everything you're using on your skin so they can help you build a routine that works together.

Q: Is this cream okay to use if I'm pregnant or breastfeeding?

A: Flawless is not recommended to be used during pregnancy or breastfeeding. Discuss further with your provider if you are pregnant or plan on becoming pregnant prior to using this medication.

IMPORTANT INFORMATION ABOUT COMPOUNDED MEDICATIONS

This medication has been compounded (custom-prepared) by a pharmacy. Compounded medications are specially prepared for individual patient needs based on a valid prescription and, as such, are not reviewed or approved by the U.S. Food and Drug Administration (FDA) for safety or efficacy. These statements have not been evaluated by the FDA.

This compounded preparation:

• Has not been approved by the FDA
• Has not undergone FDA review for safety, effectiveness, or quality
• Is prepared specifically for you based on your prescriber's order
• Individual outcomes may vary

Dosing is determined by the prescribing provider based on patient-specific factors. Always follow your healthcare provider's instructions. Compounded medications are not subject to FDA approval and lack the same safety and efficacy data as FDA-approved commercial medications. This medication should be prescribed and monitored by a licensed healthcare professional familiar with the condition being addressed and the specific applications of the medication.

1. Damoulaki E, Sioutis D, Sarli V, et al. Polycystic ovary syndrome-associated acne: the interplay of hyperandrogenism, insulin resistance, and therapeutic strategies. Cureus. 2025;17(11):e98103. doi:10.7759/cureus.98103
2. Shamim H, Jean M, Umair M, et al. Role of metformin in the management of polycystic ovarian syndrome-associated acne: a systematic review. Cureus. 2022;14(8):e28462. doi:10.7759/cureus.28462
3. Afzali BM, Yaghoobi E, Yaghoobi R, Bagherani N, Dabbagh MA. Comparison of the efficacy of 5% topical spironolactone gel and placebo in the treatment of mild and moderate acne vulgaris: a randomized controlled trial. Journal of Dermatological Treatment. 2012;23(1):21-25. doi:10.3109/09546634.2010.488260
4. Ayatollahi A, Samadi A, Bahmanjahromi A, Robati RM. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: a pilot study. Health Science Reports. 2021;4(3):e317. doi:10.1002/hsr2.317
5. Ayatollahi A, Samadi A, Bahmanjahromi A, Robati RM. Efficacy and safety of topical spironolactone 5% cream in the treatment of acne: A pilot study. Health Sci Rep. 2021 Jul 1;4(3):e317. doi: 10.1002/hsr2.317. PMID: 34250269; PMCID: PMC8247934.
6. Feng X, Shang J, Gu Z, Gong J, Chen Y, Liu Y. Azelaic acid: mechanisms of action and clinical applications. Clinical, Cosmetic and Investigational Dermatology. 2024;17:2359-2371. doi:10.2147/CCID.S485237
7. Holzer G, Riegler E, Hönigsmann H, Farokhnia S, Schmidt JB, Schmidt B. Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study. Br J Dermatol. 2005;153(3):626- 34. doi:10.1111/j.1365-2133.2005.06685.