Unblemished

• May help support clearer looking pores over time²
• Clindamycin helps address acne related bacteria¹⁰
• May calm breakouts linked to hormone abnormalities⁵
• Azelaic acid may even out skin tone by fading previous marks²
• Combining three ingredients this way encourages a multifaceted approach to acne care^1,9
• Topical application helps limit how much of each ingredient reaches systemic circulation²

Potential Side Effects

• Mild stinging, burning, or tingling⁴
• Dryness, peeling, or flaking²
• Redness or itching¹⁰
• Signs of an allergic reaction 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.
• The continuous use of topical clindamycin is limited to three months to limit bacterial resistance.

Contraindications

• A known allergy to azelaic acid, clindamycin, spironolactone, or any other ingredient in this cream
• Pregnancy, or actively trying to become pregnant, unless a provider specifically directs otherwise
• Breastfeeding, without checking with a provider first
• Use on broken, sunburned, or significantly irritated skin

Drug Interactions

Topical application of these medications often have minimal 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 body¹¹
• NSAIDs (e.g., ibuprofen, naproxen): these may lessen some of spironolactone's effects and add to potassium-related risk¹¹
• Potassium supplements or salt substitutes containing potassium: combining these with spironolactone may push potassium levels higher than intended¹¹
• Other oral or topical antibiotics (e.g., erythromycin): may decrease therapeutic effects of topical clindamycin, and increase the risk of skin irritation.

Handling Requirements

• Keep away from children and pets

Hormonal acne usually starts with high levels of androgens, a group of sex hormones that everyone has, that can send an overactive signal to the skin's oil glands.⁵ Some individuals have oil glands that are more sensitive to these type of hormone signals than others.⁵ That extra oil, combined with acne-related bacteria may cause inflammation, and may turn into deeper breakouts along the jawline and chin that is associated with hormonal acne.¹

Spironolactone posses anti-androgenic effects and a good tolerability profile.⁵ Androgen hormones bind to specific receptor on skin oil glands, resulting in the gland to increase oil production. Spironolactone blocks local androgen receptors in the skin, which may help reduce the signal at the source.⁵ This signal reduction slows down oil production from sebaceous gland potentially preventing clogged pores and inflammation.

Azelaic acid targets multiple causes of acne and has been shown to be well tolerated.⁴ It can help calm inflammation, may help limit the growth of acne related bacteria, and appears to help the skin shed dead cells more evenly so pores are less likely to become clogged.^2-4 It's also known for its gentle effect on skin tone, which may help fade marks left behind after breakouts heal.²

Clindamycin is a topical antibiotic designed to interfere with how certain acne-related bacteria build the proteins they need to grow, which may help calm the bacterial side of breakouts.¹⁰ Dermatology guidelines generally recommend pairing a topical antibiotic like clindamycin with another ingredient rather than using it alone, since combination approaches may help support the antibiotic's usefulness over time.^1,9

Q: Why combine three ingredients instead of just one?

A: Hormonal acne usually involves more than one underlying factor: extra oil production, acne-related bacteria, and inflammation. Pairing ingredients that target different mechanisms of skin blemishes is a common approach in dermatology, and may also work synergistically with each other to address inflammation, bacteria and breakouts.^1,9

Q: What exactly is hormonal acne, and how do I know if that's what I have?

A: Hormonal acne refers to breakouts linked to androgens, hormones that can overstimulate oil glands in the skin. It often shows up along the jawline, chin, or lower face and can flare up around the menstrual cycle. Some people have completely typical hormone levels but skin that responds more strongly to those hormones. A diagnosis usually comes down to a healthcare provider looking at the pattern and location of breakouts, not just a lab test.⁵

Q: Can I use this cream if I'm pregnant or breastfeeding?

A: At this time it is not recommended to use this medication while pregnant or breastfeeding due to the inclusion of spironolactone and clindamycin. ^1,5,10,11 Spironolactone is classified as pregnancy category C, animal studies have shown feminization of male fetuses.¹¹ Clindamycin should not be used during the first trimester of pregnancy due to a lack of clinical studies to support its tolerability.¹⁰

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

A: Usually, yes. It's recommended to bring in new exfoliants, retinoids, or other strong active ingredients slowly and check with a provider first, since combining several strong products at once may increase dryness or irritation. Unblemished is applied prior to other skincare products and should be allowed to absorb fully into the skin prior to applying other agents.

Q: Is there more than one form or strength of Unblemished?

A: Unblemished is currently compounded in a single strength (4% azelaic acid, 1% clindamycin phosphate, 5% spironolactone). If your provider thinks a different strength or formulation would suit you better, they can order a custom adjustment.

Q: Why is sunscreen so important with this cream?

A: Acne blemishes are more sensitive to sunlight, which raises the chance of pigmentation changes and irritation. Wearing a broad-spectrum sunscreen every day helps protect your skin while you're using Unblemished.

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. Reynolds RV, Yeung H, Cheng CE, et al., Guidelines of care for the management of acne vulgaris, Journal of the American Academy of Dermatology, 2024, 90(5):1006.e1-1006.e30, doi:10.1016/j.jaad.2023.12.017
2. 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
3. Schulte BC, Wu W, Rosen T, Azelaic acid: Evidence-based update on mechanism of action and clinical application, Journal of Drugs in Dermatology, 2015, 14(9):964-968
4. Sieber MA, Hegel JK, Azelaic acid: Properties and mode of action, Skin Pharmacology and Physiology, 2014, 27(Suppl 1):9-17, doi:10.1159/000354888
5. Vargas-Mora P, Morgado-Carrasco D, Spironolactone in dermatology: Uses in acne, hidradenitis suppurativa, female pattern hair loss, and hirsutism, Actas Dermo-Sifiliográficas, 2020, 111(8):639-649, doi:10.1016/j.adengl.2020.03.015
6. Rehan ST, Khan Z, Abbas S, et al., Role of topical spironolactone in the treatment of acne: A systematic review of clinical trials—Does this therapy open a path towards favorable outcomes?, Journal of Dermatology, 2023, 50(2):166-174, doi:10.1111/1346-8138.16637
7. 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
8. 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
9. Canavan TN, Chen E, Elewski BE, Optimizing non-antibiotic treatments for patients with acne: A review, Dermatology and Therapy, 2016, 6(4):555-578, doi:10.1007/s13555-016-0138-1
10. Murphy PB, Bistas KG, Patel P, et al. Clindamycin. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519574/
11. Patibandla S, Heaton J, Kyaw H. Spironolactone. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554421/