Psoriasis is a common dermatologic problem faced by approximately 2% of Americans. Symptoms typically include dry skin, which may be thickened or red with a scaly appearance, swelling, itching, and soreness. Whereas it is generally not a debilitating condition, psoriasis can negatively affect quality of life with its often unpleasant symptoms. Many prescription treatments are available to alleviate symptoms, and a compounding pharmacy can offer a host of additional treatment options for the management of psoriasis.1
Although early onset is possible, psoriasis occurs primarily in adults and begins in the immune system with an overproduction of T cells. The exact trigger for this proliferation of cells is unclear; however, evidence shows that the cause is likely multifactorial. A genetic predisposition to the disease appears to exist, but environmental factors also play a major role in the development and severity of psoriasis. Environmental stimuli such as injury, infection, medications, stress, and dry, harsh climate conditions likely contribute to the development of psoriasis.
Psoriasis can be difficult to treat, and traditional methods do not work for all patients.Topical treatment is typically the first line of defense and may work well for many patients with mild-to-moderate cases. Some topical treatments are commercially available in certain strengths and forms, either by prescription or over the counter, including the following:
Other treatment options include the use of systemic therapy, which generally is reserved for patients with moderateto- severe cases and may cause adverse effects. Systemic medications used to treat psoriasis include cyclosporine (Neoral), methotrexate, acitretin (Soriatane), isotretinoin (Accutane), and sulfasalazine (Azulfidine).2
Whereas commercial topical treatments can be effective for many patients, other patients with more severe cases may require a specialized prescription available from a compounding pharmacist. In such cases, a wide variety of options are available to the physician and the patient without having to resort to systemic therapy.
One product that has proven successful in some patients is a preparation of zinc pyrithione 0.02% in a topical spray or solution. Clobetasol 0.05% may be added to this compound and can further enhance its effectiveness.3 This preparation, formerly marketed under the brand name Skin Cap, was pulled from the US market when it was found to contain an unlabeled percentage of clobetasol. Physicians who found the product effective with their patients, however, have been able to refer the patients to compounding pharmacies, where the product can be compounded.
Certain systemic treatments may be converted to topical forms to meet the needs of a patient without exposing the whole body to the medication. Cyclosporine, a treatment option that generally is used systemically, has shown a degree of effectiveness in topical forms for the treatment of psoriasis, and it also may be prepared according to a doctor's specifications.4 Tacrolimus, another systemic treatment for psoriasis, has shown effectiveness in topical compounded form when used after the lesions have been descaled and the skin has been occluded.5,6
Compounded treatments also may include combinations of topical steroids, coal tar, or salicylic acid in varying strengths and vehicles that may not be commercially available. These medications may be prepared in bulk and may be more cost-effective for some patients.
New research indicates other promising treatments, including the use of pentoxifyllin (PTX) topically. PTX has been shown to trigger a variety of physiologic changes at the cellular level. The results of other new studies indicate that the use of topical vitamin D analogues such as calcipotriol and calcitriol may be appropriate. These drugs inhibit T-cell proliferation and inhibit inflammatory mediators, and they have demonstrated effectiveness with good tolerance and systemic safety.5,7-9
Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.
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