Psoriasis is a common dermatologicproblem faced by approximately2% of Americans. Symptomstypically include dry skin, which may bethickened or red with a scaly appearance,swelling, itching, and soreness. Whereasit is generally not a debilitating condition,psoriasis can negatively affect quality oflife with its often unpleasant symptoms.Many prescription treatments are availableto alleviate symptoms, and a compoundingpharmacy can offer a host ofadditional treatment options for the managementof psoriasis.1
Although early onset is possible, psoriasisoccurs primarily in adults and beginsin the immune system with an overproductionof T cells. The exact trigger forthis proliferation of cells is unclear; however,evidence shows that the cause islikely multifactorial. A genetic predispositionto the disease appears to exist, butenvironmental factors also play a majorrole in the development and severity ofpsoriasis. Environmental stimuli such asinjury, infection, medications, stress, anddry, harsh climate conditions likely contributeto the development of psoriasis.
Psoriasis can be difficult to treat, andtraditional methods do not work for allpatients.Topical treatment is typically thefirst line of defense and may work wellfor many patients with mild-to-moderatecases. Some topical treatments are commerciallyavailable in certain strengthsand forms, either by prescription or overthe counter, including the following:
Other treatment options include theuse of systemic therapy, which generallyis reserved for patients with moderateto-severe cases and may cause adverseeffects. Systemic medications used totreat psoriasis include cyclosporine(Neoral), methotrexate, acitretin (Soriatane),isotretinoin (Accutane), and sulfasalazine(Azulfidine).2
Whereas commercial topical treatmentscan be effective for manypatients, other patients with more severecases may require a specialized prescriptionavailable from a compounding pharmacist.In such cases, a wide variety ofoptions are available to the physician andthe patient without having to resort tosystemic therapy.
One product that has proven successfulin some patients is a preparation ofzinc pyrithione 0.02% in a topical spray orsolution. Clobetasol 0.05% may be addedto this compound and can furtherenhance its effectiveness.3 This preparation,formerly marketed under the brandname Skin Cap, was pulled from the USmarket when it was found to contain anunlabeled percentage of clobetasol.Physicians who found the product effectivewith their patients, however, havebeen able to refer the patients to compoundingpharmacies, where the productcan be compounded.
Certain systemic treatments may beconverted to topical forms to meet theneeds of a patient without exposing thewhole body to the medication. Cyclosporine,a treatment option that generallyis used systemically, has shown adegree of effectiveness in topical formsfor the treatment of psoriasis, and it alsomay be prepared according to a doctor'sspecifications.4 Tacrolimus, another systemictreatment for psoriasis, has showneffectiveness in topical compoundedform when used after the lesions havebeen descaled and the skin has beenoccluded.5,6
Compounded treatments also mayinclude combinations of topical steroids,coal tar, or salicylic acid in varyingstrengths and vehicles that may not becommercially available. These medicationsmay be prepared in bulk and maybe more cost-effective for some patients.
New research indicates other promisingtreatments, including the use of pentoxifyllin(PTX) topically. PTX has beenshown to trigger a variety of physiologicchanges at the cellular level. The resultsof other new studies indicate that theuse of topical vitamin D analogues suchas calcipotriol and calcitriol may beappropriate. These drugs inhibit T-cellproliferation and inhibit inflammatorymediators, and they have demonstratedeffectiveness with good tolerance andsystemic safety.5,7-9
Ms. Fields is with the InternationalJournal of PharmaceuticalCompounding and is a pharmacytechnician at Innovative PharmacyServices in Edmond, Okla.
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