His wife had a common skin condition and tried expensive creams for over 20 years. She became 'patient zero' for his personalized skincare company — and had clear skin in a month.

• Personalized skincare brands are booming in popularity.
• Musely specializes in antiaging skincare and customized formulas with prescription ingredients.
• This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.

For 20 years after getting pregnant, Cherry Jia tried everything to fade the dark patches on her face. After giving birth to her son, she had melasma, a fairly common skin discoloration caused by hormonal fluctuations during pregnancy.

Since the late '90s, she'd tried over-the-counter products, topical prescriptions, and in-office procedures like laser treatments, with little to no improvement. Even her husband's products didn't work for her. Jack Jia founded Musely Marketplace, an online beauty company that recruited over 3,000 brands and used influencers (or "muses") to promote the products through the platform. The treatments they sold for dark spots had no effect on her skin.

The site launched to much fanfare, but based on feedback from Cherry, some customers, and the influencers who worked for Musely at the time, "that's where we also start to realize a lot of these products that actually don't work," Jack Jia told Business Insider.

It struck him that hundreds of the products sold on his marketplace used the same few corporate manufacturers with "nearly identical creams and formulas," he said, making them about as effective as "scented water."

Jia asked Dr. Marie Jhin, a dermatologist he'd hired to help curate the products, to give him the inside scoop: Is there anything you can buy over the counter that's broadly effective for most people? No, Jhin said. "If you want something that works, you have to go prescription." He heard the same thing from Musely's other advisors, Lori Bush, the former president and CEO of the skincare company Rodan and Fields, and Kimber Maderazzo, the former executive vice president and general manager of Proactiv.

But, they told him, dermatologists are able to create their own prescription-grade, personalized formulas through a pharmaceutical practice known as "compounding." As long as you're working with dermatologists, you can produce some really creative and effective products, they said. Jia was sold.

With Jhin's help, he decided to relaunch the company as Musely and sell only its own products — ones with stronger concentrations of active ingredients than those found in drugstores.

Though she was reluctant to try yet another treatment after so many failed attempts, Cherry became "patient zero" and was prescribed an early iteration of the company's Spot Cream, formulated by Jhin.

Cherry's drastic improvement within 30 days solidified Jack Jia's confidence in his new teledermatology brand.

"We realized 90 to 95% of our melasma patients were very similar to her," he said. "They tried everything in the past." The trickiest part would be convincing them that this time would be different.

Using an old-school pharmaceutical practice to disrupt the skincare market

If you're looking for drastic antiaging results, most dermatologists recommend getting a prescription retinoid like tretinoin, a vitamin A derivative that stimulates new cell growth in your skin. That requires a visit to the dermatologist and the pharmacist.

Musely is able to sell tretinoin-based products online through two methods. It employs 25 board-certified dermatologists who virtually assess clients by looking at photos of their skin. Then, the dermatologists create their own formulas, a process called "compounding."

Compounding is a common practice in pharmacies that exists in a legal gray area. It's a way to create prescription medications that fit an individual patient's needs by altering the dose of specific ingredients. By definition, each unique formula is entirely new and, therefore, does not fit into any regulatory framework.

This is the core of Musely's business model. It has a range of products, and its consulting dermatologists can tinker with the ingredients to fit a consumer's needs. For example, Musely's Anti-Aging Cream, which comes in three variations from "gentle" to "veteran," contains different levels of tretinoin depending on a customer's skin sensitivity.

Musely also looks at what its clients are buying and asking for to develop new lines of original products. Jia said Musely's top-selling products treat aging concerns like dark spots, rosacea, and hair thinning. It recently devised an Aging Repair Cream, which incorporates 0.3% estriol, a mild form of bioidentical estrogen that promotes hydration and firmness.

Jia said the cream has been "extremely popular" among women over 40 looking to restore elasticity to their skin. While estriol isn't FDA-approved, can cause side effects like nausea and weight gain, and has been linked to an increased risk of breast or uterine cancer, Jia said Musely's chief science officer combs through existing studies before incorporating new ingredients. Musely also conducts "consumer efficacy studies," recruiting 60 to 200 volunteers to test "major new products" for 60 days. Jia said they've completed this process six times so far.

Another result of consumer polling was the Private Cream, designed to lighten dark spots on the genitals, anus, and underarms after customers mentioned it as a concern. This, too, can be personalized to fit a consumer's unique needs, such as swapping hydroquinone, a depigmentation ingredient, with tranexamic acid, a milder alternative.

Cheaper and faster

Musely isn't the only teledermatology brand to employ compounding: Brands like Curology, Dermatica, Dear Brightly, and Apostrophe are among some of the competitors who have in-house dermatology teams and deliver customized subscription products.

Part of the boom comes from the desire for products that target specific skin concerns, like dark spots or wrinkles. Even nonprescription skincare brands like Proven, which only requires completing an AI-powered quiz, can curate products based on a customer's skin type, age, and existing habits. Startups are now competing to offer personalized products, from hair care to weight-loss drugs.

Another appealing factor is the price: A 2017 research paper found the average dermatologist visit costs $221, and a tube of tretinoin can cost anywhere from $59 to $300, depending on your insurance (or lack thereof).

Musely charges $20 for an online consultation, and anywhere from $27 to $99 a month, depending on the treatment. It also includes 60 days of access to a dermatologist for "an unlimited number of questions you may have," Jia said. If the dermatologist isn't available, the company uses AI-powered chatbots to help customers learn how to use their new prescriptions.

Beyond the cost, it's also much easier to snap a quick selfie than it is to schlep to a dermatologist's waiting room. "In about three minutes you can finish your visit — that makes the process so much simpler and so much quicker," Jia said.

The ease of access poses some risks. Last year, The New York Times reported that some teledermatology companies had created compounds that don't make sense, such as mixing tretinoin with benzoyl peroxide, which deactivates it, or using too much niacinamide, which can irritate the skin.

Adapting in real time

Jack Jia said Musely continues to create new formulas. Because its dermatologists see a higher volume of patients than they would in an office, Jia said one doctor might see more melasma patients on the Musely platform in one week than in 10 years of their office practice.

"We started out with just two treatments with maybe eight different formulas," he said. "Today, we have 16 different treatments and 100-plus formulas."

Its consumer base has expanded, too. Jia said Musely started out by targeting the same age ranges as competitors like Hers, Apostrophe, and Curology, with a huge focus on acne products.

"We didn't market to anyone over 60," he said. But after investing in products like an estrogen cream for menopause and a body cream for dark spots, it saw its clientele's median age rise to 45, with its oldest clients in their 90s.

"There's a lot of flexibility," Jia said of Musely's product-development process. "If you're seeing an issue, then you can address it very quickly."