Vitality Plus

• Supports collagen production and skin thickness ^1,2
• Reduces fine lines and signs of photoaging ^3,4
• May help minimize unwanted facial hair growth ^5,6
• Improves skin hydration and barrier function ^7,8
• Reduces skin discoloration and uneven tone ^3,8
• Addresses estrogen-related skin thinning after menopause ^1,2
• Offers multi-target skin support in a single daily step ⁹

Potential Side Effects

Most possible side effects from this cream are local and mild. The following have been reported with the individual active ingredients:

• Skin irritation, redness, dryness, and flaking (tretinoin) — most common during the first few weeks of use; typically improves with continued use.⁴
• Increased sun sensitivity (tretinoin) — the skin may burn more easily in sunlight while using this product; daily sunscreen use is essential.⁴
• Mild skin irritation or stinging at the application site (tretinoin, estriol).¹⁴
• Temporary increase in pimples or skin purging (tretinoin) — this is common in the first 4–6 weeks as increased cell turnover brings clogged pores to the surface.³
• Local skin irritation or hair follicle sensitivity (finasteride topical) — less commonly reported with topical versus oral forms.⁵
• Flushing or mild redness (niacinamide, particularly at higher concentrations) — usually transient and resolves with regular use.⁸
• Skin lightening beyond the intended areas (niacinamide, tretinoin) — apply only to targeted areas as directed.³

Warnings & Precautions

• Always use a broad-spectrum sunscreen (SPF 30 or higher) every morning while using this cream. Tretinoin makes the skin more vulnerable to UV damage.
• Allow for an adjustment period of 2–4 weeks. Some dryness, peeling, or mild irritation is expected when starting tretinoin-containing products.
• Do not use on broken, sunburned, or irritated skin. Allow any active skin conditions to heal before applying.
• Avoid strong exfoliating products (glycolic acid, salicylic acid, physical scrubs) unless the prescribing provider advises that it is safe to combine them.
• Avoid contact with eyes, nostrils, and the corners of the mouth — these areas are sensitive to retinoid irritation.
• Use only as prescribed. Do not increase frequency or amount without speaking to the provider.
• This product contains a hormonal ingredient (estriol). Patients with a personal or family history of hormone-sensitive conditions should discuss this with their provider before use.

Contraindications

• Pregnancy and breastfeeding — tretinoin is teratogenic (harmful to a developing fetus) and should not be used during pregnancy. Finasteride is also contraindicated in pregnancy. Women who are or may become pregnant should not use this product.⁴⁹
• Known allergy or hypersensitivity to any of the active ingredients — including estriol, finasteride, tretinoin, or niacinamide.
• History of estrogen-sensitive cancers (e.g., certain breast cancers) — estriol is a form of estrogen; patients with a history of hormone-sensitive malignancies should use only with explicit provider and oncologist guidance.
• Active inflammatory skin conditions (eczema, seborrheic dermatitis, rosacea in a flare) at the site of application — tretinoin and estriol may worsen active inflammation.
• Children and adolescents — this product is not intended for pediatric use.

Drug Interactions

Because this cream is applied topically and systemic absorption is generally low, significant drug interactions are uncommon. However, patients should inform their provider and pharmacist of all medications and supplements they are using.⁹

• Oral retinoids (e.g., isotretinoin, acitretin): Combining oral and topical retinoids can increase the risk of retinoid toxicity, including severe skin dryness and irritation. Do not use concurrently without provider guidance.
• Oral finasteride or dutasteride: If a patient is also taking an oral 5-alpha reductase inhibitor, combined use with topical finasteride should be discussed with the provider to avoid cumulative DHT suppression.
• Topical products containing benzoyl peroxide, AHAs, or BHAs: These can interact with tretinoin and increase skin irritation. Use on alternating evenings if needed, or separate by time, unless directed otherwise.
• Photosensitizing medications (e.g., certain antibiotics, diuretics): Tretinoin already increases UV sensitivity; combining with other photosensitizing agents may increase sunburn risk further.

The skin is a living structure that relies on a combination of signals, proteins, and cells to stay firm, smooth, and hydrated. With age — and particularly after menopause — several of these signals weaken at once. Estrogen levels fall, causing collagen production to slow. Vitamin A (retinoid) activity in the skin declines. Melanin distribution becomes uneven, causing spots and dullness. And in some women, hormonal changes drive unwanted hair growth on the face. Vitality Plus Cream addresses all four of these changes simultaneously, with each ingredient targeting a different piece of the puzzle.^1,3 

Estriol works by binding to estrogen receptors found in skin cells, including the collagen-producing fibroblasts in the deeper layers of the skin. By restoring some of this hormonal signaling locally, estriol helps stimulate the rebuilding of collagen and elastin, improve skin thickness, and enhance moisture retention. ^1,2

Tretinoin acts like a reset signal for skin cells. It works in two key ways: it blocks enzymes that break down collagen, and it directly triggers new collagen and elastin production by activating specific receptors inside skin cells. This is why tretinoin has such a well-established track record in dermatology — it addresses aging at the cellular level rather than just on the surface. It also speeds up the skin cell turnover cycle, which helps fade discoloration and smooth texture over time.^3,4

Finasteride, when applied topically, works locally in the hair follicle to block an enzyme called 5-alpha reductase. This enzyme converts testosterone into a more potent form (DHT) that stimulates hair follicles to produce coarser, darker, more visible hair in androgen-sensitive areas. By blocking this conversion at the follicle level, finasteride helps slow or minimize unwanted facial hair growth. The topical route is used here specifically to minimize systemic absorption while still delivering the active ingredient to the target area.^5,6

Niacinamide works on multiple levels as a calming and supportive ingredient in this combination formula. It minimizes the transfer of melanin (pigment) from melanocyte cells to the surrounding skin cells, helping lighten dark spots. It also strengthens the skin’s outer barrier by promoting the production of ceramides and fatty acids, which help the skin hold onto moisture and resist irritation — a benefit that may also help offset the dryness and sensitivity that tretinoin can sometimes cause during initial use.^7,8

Q: Why does my skin change as I get older, especially after menopause?

A: The skin is actually very hormone-sensitive. Estrogen plays a big role in keeping the skin firm, thick, and hydrated by supporting the cells that make collagen. After menopause, when estrogen levels drop, the skin can lose up to 30% of its collagen in the first five years. This is why many women notice their skin becoming thinner, drier, and more wrinkled quite quickly. At the same time, vitamin A activity in the skin also decreases with age, which slows down cell renewal and makes uneven pigmentation more visible.

Q: Why is finasteride included in a skin cream?

A: Sometimes, a hormonal changes — particularly shifts in androgen levels — cause the hair follicles on the face and neck to produce darker, thicker, and more visible hair than before. This is called hirsutism. Finasteride works by blocking the enzyme that converts testosterone into a more powerful form (DHT) that triggers this type of hair growth. When applied topically, it targets the follicles in the treated area directly, without the possibility of side effects associated with taking it as a pill.

Q: How soon should changes be expected?

A: Changes in skin from this cream tend to build gradually over weeks to months, and different benefits may appear at different rates. Some improvements in skin hydration and tone may become noticeable within the first 4–8 weeks. Tretinoin’s anti-wrinkle and skin-smoothing effects typically become more visible after 3–6 months of consistent nightly use. Reduction in facial hair growth with finasteride may take 3–6 months or longer. It is important to continue using the cream consistently, even if changes are not immediately visible.

Q: What should be done about sun exposure while using this cream?

A: Sun protection is very important while using this cream, because tretinoin makes the skin more sensitive to UV rays. Applying it in the evening (as directed) helps limit daytime sun exposure, but using a broad-spectrum sunscreen of SPF 30 or higher every morning is essential. Hats and protective clothing are also helpful on days with significant sun exposure. Avoiding tanning beds is also recommended while using this product.

Q: What if the skin becomes red, flaky, or irritated after starting the cream?

A: Some redness, flaking, and sensitivity is normal during the first 2–4 weeks of tretinoin use. This is part of the skin’s adjustment period as cell turnover increases. It usually settles down on its own. To minimize discomfort, the provider may recommend applying the cream every other night at first, then building up to nightly use. Using a gentle, fragrance-free moisturizer after the cream dries can also help. If irritation is severe or does not improve after a few weeks, contact the prescribing provider.

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 from a prescribing healthcare practitioner and, as such, are not reviewed or approved by the U.S. Food and Drug Administration (FDA) for safety or efficacy. Compounded drugs are intended for patients whose prescriber has determined their medical needs are not met by an available FDA-approved drug. 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.    Schmidt JB, Binder M, Demschik G, Bieglmayer C, Reiner A. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35(9):669–674. doi:10.1111/j.1365-4362.1996.tb03694.x

2.    Stevenson S, Thornton J. Effect of estrogens on skin aging and the potential role of SERMs. Clin Interv Aging. 2007;2(3):283–297. doi:10.2147/cia.s798

3.    Mukherjee S, Date A, Patravale V, et al. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1(4):327–348. doi:10.2147/ciia.2006.1.4.327

4.    Bagatin E, Esposito ACC, Freitas THP, Aguiar GBF, Tamura BM. Systematic review of tretinoin for photodamaged skin. Dermatol Ther (Heidelb). 2019;9(4):635–654. doi:10.1007/s13555-019-00326-7

5.    Moghetti P, Castello R, Negri C, et al. Clinical and hormonal effects of the 5 alpha-reductase inhibitor finasteride in idiopathic hirsutism. J Clin Endocrinol Metab. 1994;79(4):1115–1121. doi:10.1210/jcem.79.4.7962284

6.    Tartagni M, Schonauer MM, De Salvia MA, et al. Finasteride cream in hirsutism. Endocr Pract. 2001;7(1):5–10. doi:10.4158/EP.7.1.5

7.    Bissett DL, Oblong JE, Berge CA. Niacinamide: A B vitamin that improves aging facial skin appearance. Dermatol Surg. 2005;31(s1):860–866. doi:10.1111/j.1524-4725.2005.31732

8.    Pullar JM, Carr AC, Vissers MCM. The roles of vitamin C in skin health. Nutrients. 2017;9(8):866. PMID: 28805671 — see also: Hakozaki T, Minwalla L, Zhuang J, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20–31. doi:10.1046/j.1365-2133.2002.04834.x

9.    Kang S, Voorhees JJ. Pharmacology of Skin Aging. In: Goldsmith LA, Katz SI, Gilchrest BA, et al., eds. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012.

10. Sonthalia S, Daulatabad D, Sarkar R. Glutathione as a skin whitening agent: Facts, myths, evidence and controversies. Indian J Dermatol Venereol Leprol. 2016;82(3):262–272. — cited here for background on compounded multi-ingredient topical formulations. See also: Habif TP. Clinical Dermatology. 6th ed. Edinburgh: Elsevier; 2015.