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There’s one little corner of the vast morass of Reddit where earnest reviews and detailed knowledge sharing are valued: the Skincare Addiction subreddit. The good people of this subreddit pounce on and dissect any new and promising skincare treatment as soon as it hits the scene.
Over the last 18 months, Curology, an online acne treatment startup, has become a fixture in mentions there. A typical example of the kind of glowing comment you’ll find: “Curology is THE BEST. I always try to get people to try it but they never do, I guess because the way I talk about it, it sounds too good to be true. But jesus. Just last week I went outside without makeup for the first time in over five years and I got so many compliments.”
Curology is a two-year-old online service that, for $19.95 a month, matches patients up with one of the two dermatologists or ten nurse practitioners that it employs. Those Curology providers then prescribe and send the patient custom topical medications mixed in Curology’s own compounding pharmacy. This unique feature is what single-handedly distinguishes Curology from more generic online telemedicine services like Spruce, which still requires you to go a pharmacy, and subscription over-the-counter acne treatment systems like Proactiv, which are not prescription strength.
Curology’s focus is mostly on acne, but it also has a growing side business aimed at ingredient-savvy patients (yes, like skincare redditors) looking for affordable prescription anti-aging creams. On Curology, you can get treatments like tretinoin, the generic version of Retin-A, that you can’t just pick up at Sephora. But if you have a wonky-looking rash or a suspicious mole, this is not the place to go — it’s pimples and wrinkles only.
Approximately 40 to 50 million people suffer from acne, according to the American Academy of Dermatology. Studies have shown over and over that chronic acne sufferers are at higher risk for depression. A big treatment industry with two distinct arms has popped up in response, neither of which serves acne sufferers very well. First, you can try over-the-counter medications, which are plentiful and inexpensive but often frustratingly ineffective. Or, you can try to find a dermatologist, which can be expensive or not that accessible, depending on your location and insurance coverage. A lot of people fall through the cracks.
Dr. David Lortscher followed in his dermatologist mom’s footsteps, getting his M.D. in 2012. He’s from California, but his first practice was in Albuquerque, New Mexico, where dermatologists aren’t as available as in more populated parts of the country. “It was as soon as I started seeing patients as a dermatologist that I saw the system was broken.”
“I realized for the average person, it’s completely inaccessible and unaffordable to see a dermatologist,” he says.
Patients with acne usually need to see a dermatologist approximately two to four times a year, which can cost $20 to $60 per visit with an average insurance co-pay, according to Dr. Lortscher. The patients who respond to prescription topical creams – and don’t need more heavy-duty treatments – usually needed two to three separate prescriptions, which can cost anywhere from $5 to $200 a pop depending on coverage. Then there’s a separate trip to the pharmacy to pick them up. Dr. Lortscher says patients told him they avoided seeing a doctor for acne for a long time because they “thought dermatologists were for rich people.”
Dr. Lortscher envisioned an online service to make prescription acne treatments more accessible without the expense and hassle of seeing a dermatologist and dealing with a pharmacy in real life. He started Curology in 2014 with his brother, Glenn Lortscher, who is a programmer and the CTO of the company.
One of the first hurdles Curology had to overcome was getting its medical team licensed in all 50 states. Every state has different laws governing the practice of telemedicine and prescribing medications. As it stands now, Curology has practitioners licensed in 42 states. If you live in Arkansas, Delaware, Indiana, Louisiana, Mississippi, Oklahoma, South Carolina, or West Virginia, you’re temporarily out of luck and can’t use the service.
The company was originally called PocketDerm for several months, but Dr. Lortscher says he changed the name because he took a survey and found out that “people hated it.” (In true divisive internet form, there’s a Reddit thread absolutely skewering the new name, with one poster writing, “Curology sounds and looks ugly. Not to mention, the cult associations conjure connotations of blind faith, rigid dogma and bad science.”) Branding aside, this past August the company landed a second round of VC funding worth $15 million and the subscriber base has been increasing every month since launch.
To start using the service, you upload pictures of your skin and answer a questionnaire about your lifestyle habits, any medications you’re on, treatments you’ve tried in the past, and medical history. A dermatologist or nurse practitioner will communicate with you via email about your concerns and then send you your prescription, as well as give you some basic diet and lifestyle advice, like cutting back on sugar.
The $19.95 a month gets you unlimited online consultations with your provider and a prescription cream. The prescription is re-sent to you every three months, but if you use it up before then you can request a refill sooner without paying anything extra. To put the math more plainly, you’re effectively paying $60 per bottle. And to further put this pricing into perspective, a name-brand tube of prescription Retin-A Micro will set you back almost $300. A generic version at my dermatologist’s office is $50, and that only includes one type of active ingredient. Curology’s includes three.
“All these meds, they were invented over four decades ago and they’re off-patent. The raw ingredients to make tretinoin are as cheap as the raw ingredients to make Tylenol,” claims Dr. Lortscher. “You should be able to get those meds for $20, and the fact that you can’t is a reflection of our medical system and all these intermediaries and business people who mark them up like crazy. It was really important to us to make them affordable.”
Affordable is all relative, of course. One Curology acne patient, beauty blogger Jamie, 27, of Vanity Rex, says, “If you think of it as [only] skincare products, it’s kind of expensive.” Which is true if you consider that a tube of Clean & Clear Persa-gel costs $4.99 at Target.
But for Jude Chao, 36, who blogs about Asian beauty products at Fifty Shades of Snail and accesses Curology to get prescription tretinoin for anti-aging purposes, it’s a bargain. “I worked out the per bottle price for myself every nine weeks like clockwork, two pumps everyday –it’s $45 per bottle. That’s the same price as a normal midrange serum that doesn’t have anywhere near the proven ingredients, most likely doesn’t come in the concentrations it has in this product, and it really works,” she says. (It should be noted that both bloggers now get their prescriptions for free because they’ve built up so much referral credit, a practice that Curology, like many other beauty companies, uses to gain new customers.)
To effectively treat acne, it’s recommended to use drugs with different mechanisms of action, which is why Curology mixes three together. “Compounded acne medications are gaining interest worldwide because the inclusion of multiple acne-targeting ingredients in one product is deemed successful in treating acne,” Georges Lahoud, PharmD, PhD, a compounding pharmacist at Mills Pharmacy and Apothecary in Birmingham, Michigan, writes in an email.
A typical prescription for acne from Curology might contain 0.018% tretinoin, 8% azelaic acid, and 1% clindamycin. One for anti-aging and dark spots might contain 5% of a vitamin C derivative, 0.04% tretinoin, and 4% niacinamide. Providers then tweak prescriptions and concentrations as needed based on how they’re working and how patients tolerate them. Dr. Lortscher says that in about a third of cases, some tweaks are necessary. Jamie went through several versions before finding a formula that worked for her.
There are some potential issues there, though, because pharmacology involves complex chemistry — you can’t just toss a bunch of medicines into a base and assume they’ll all still work fine. “The addition of multiple ingredients into one topical medication increases the odds of chemical interaction, physical instability, or product degradation,” says Lahoud.
Dr. Lortscher is aware of this and recognizes it as a limitation. “We don’t do any combinations that haven’t been through the R&D process. Let’s say I see a patient where I would like a formulation we’ve never made before. We won’t just make that,” he says. “After we’ve seen enough patients where we’re like, You know what, this should exist, we’ll put it through the R&D process. That’s a six-month long process.”
The patients have seen it as a limitation, too, and it’s one of the more common complaints about the service, according to both Jamie and Jude. They say that the customized medicine and advice claims don’t quite live up to the dream of true customization. “I’ve been hearing a lot of frustration around some of the canned responses [patients receive from providers]. There’s also a limited number of formulas and a lot of people get the same formula to start,” says Jamie. Jude agrees, but notes, “It’s a minor complaint because you’re kind of going for the one big active [ingredient] that you want. The other stuff is a bonus.”
Jude also notes that Curology may be going through some growing pains. “I’ve been hearing people complain more that their providers haven’t been getting back to them as quickly as they expected,” she says. It’s another thing that Dr. Lortscher has tacitly acknowledged. He says some of the new investment money is being used to hire more staff.
While Dr. Lortscher says he knew nothing about Reddit when he first started the service, Curology has really embraced its online fans. It now advertises on Facebook, it has purchased promoted posts on Reddit, its staff does frequent Q&As on Facebook Live, and it boasts over 20,000 followers on its Instagram page, where it frequently posts before and after pictures that patients send in. All of it is apparently working to attract new customers.
Both bloggers say that they’ve had to stay on top of their providers and actively request changes. They agree that someone with a bit of skincare ingredient savvy and a good understanding of their own skin will probably have a better experience with the service.
“Our patients are extremely savvy, more savvy than the average patient I saw in my office dermatology practice. They’re more proactive in thinking about skincare and sun protection,” says Dr. Lortscher. Tretinoin in particular can cause dry, flaky skin (a side effect Jamie has had to deal with), and other ingredients Curology uses can be allergenic, so you can’t be cavalier about it. You need to respect that these are prescription-strength topicals.
The final limitation to be aware of is that Curology is best for moderate acne. If you require oral medications like Accutane or spironolactone or could benefit from in-office treatments like blue light therapy, you’ll need to see a dermatologist in real life. The providers at Curology can let you know if and when you ever hit that stage.
But for a lot of people the service is a godsend, and the sheer number of before and after pictures shared with Curology’s various social media platforms indicate many happy customers.
“I don’t have acute skin problems that I would feel it was a priority to go out and find a dermatologist and physically go to the office and deal with all that stuff,” says Jude. “It’s a super smart way to offer prescription level of skin care to people without putting them through the hoops you normally would have to go through.”