Compounding Useful in Dermatology

Shannon W. Fields, BA, CPhT
Published Online: Thursday, November 1, 2007

Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.


The practice of compounding has long been a major part of dermatology— from cosmetics, to skin care, to custom prescriptions. Dermatologic preparations can foster a significant amount of business for compounding practices when commonly used preparations are properly marketed to local clinicians. Skin conditions such as acne, solar lentigines, psoriasis, and warts can often be treated successfully with the help of an experienced compounding pharmacist.

Acne

Acne vulgaris is often an embarrassing and uncomfortable condition, characterized by the appearance of pimples on the face, neck, or trunk. When OTC treatments such as benzoyl peroxide fail to clear up the problem, topical compounds may provide a viable alternative to systemic therapies such as isotretinoin or tetracycline.

Niacinamide gel has been reported to provide relief in some patients with moderate acne.1,2 A 4% niacinamide gel in water and propylene glycol, thickened with Carbopol 940 and trolamine, may be applied twice daily for the treatment of mild-to-moderate acne vulgaris.

Studies have shown that for acne scarring, estriol 0.03% solution for iontophoresis may be effective in improving the appearance of the skin.3 This method has been shown to improve the appearance of atrophic acne scars in patients, and the effects were still present a year after the study ended.

Solar Lentigines and Skin Aging

Solar lentigines, also commonly referred to as age spots or liver spots, are areas of increased pigmentation brought about by exposure to sunlight or other forms of ultraviolet light. These areas may be treated effectively with compounded preparations such as bleaching creams or topical estrogens.

Many dermatologists prescribe topical bleaching agents containing components such as hydroquinone, retinoic acid, and vitamin E in various combinations and strengths, sometimes with an added corticosteroid. Often these preparations are tailored to the patient's needs, and compounding is necessary.

Topical estrogens also may be used in the treatment of age spots and may improve elasticity.4 Estriol, in particular, appears to have a significant positive effect on collagen, without the systemic side effects that may occur with the use of stronger estrogens such as estradiol. Estriol may be prepared in a topical cream or gel typically ranging in strength from 0.5% to 2% to be applied daily as directed.5

Psoriasis

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. While commercially available treatments may be effective for many patients, others 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 for many patients is a preparation of zinc pyrithione 0.2% in a topical spray or solution. Clobetasol 0.05% may be added to this compound and can further enhance its effectiveness.6

Commonly used systemic medications also may be converted to topical forms to meet the needs of a patient without exposing the whole body to the medication. Cyclosporin, a treatment option that is generally used systemically, has shown a degree of effectiveness in topical forms for the treatment of psoriasis and may be prepared according to a doctor's specifications.7

Warts

Warts are a common infection caused by viruses in the human papillomavirus family. When OTC remedies fail, compounding allows for a host of additional treatment options. For common warts, dinitrochlorobenzene or diphenylcyclopropenone (0.1% to 0.3%) may be prepared in a lactic acid and salicylic acid base for home application. Other preparations such as trichloroacetic acid, 5-fluorouracil, cantharidin, and podophyllum may be prepared in various vehicles and are typically prepared for in-office treatment.

References

  1. Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995;34:434-437.
  2. Allen LV Jr. Niacinamide 4% acne gel. IJPC. 2001;5:49.
  3. Allen LV Jr. Estriol solution for iontophoresis for acne scars. IJPC. 1997;1:411.
  4. Schmidt JB, Binder M, Demschik G, Bieglmayer C, Reinder A. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35:669-674.
  5. Allen LV Jr. Estriol 2-mg/mL topical gel. IJPC. 2002;6:299.
  6. Mason D, Carroll T. Case reports: Steroid substitute treatment for psoriasis. IJPC. 1999;3:34.
  7. Feliciani C, Tulli A. Topical cyclosporin in the treatment of dermatologic diseases. Int J Immunopathol Pharmacol. 2002;15:89-93.
  8. Allen LV Jr. Basics of compounding for the treatment of warts. IJPC. 2004;8:126-129.




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