Compounding
combines an ageless art with the latest medical knowledge and state-of-the-art technology, enabling specially trained professionals to prepare customized medications that are just what the doctor ordered.

Customized Medications Offer Alternatives & Advantages for Dermatology

ü      Change in Dosage Form - If a patient is unable to take commercially available medications, has not responded, or experienced adverse effects, numerous options exist. We can compound the needed drug(s) into different dosage forms, such as cosmetically appealing creams, ointments, transdermal gels, topical sprays and powders, troches, lozenges, lollipops, or freezer pops.

ü      Change in Route of Administration - A medication may only be commercially available as an oral or injectable product, but we can provide additional therapeutic options by compounding an alternate dosage form for a different route of administration, For example, medications are commonly administered systemically by using transdermal gels, which are beneficial in patients who can not take oral medication or who have hepatic disease, as the medication is not subject to “first pass” hepatic metabolism.

ü      Combination Preparations - We may combine compatible drugs into a single dosage form to simplify a medication administration schedule, and improve compliance. Also, a synergistic effect can be achieved when certain medications are used in combination.

ü      “Unavailable” Medications - When a medication is temporarily unavailable or has been discontinued by the manufacturer due to declines in usage or low profits, we can usually obtain the needed drug as a bulk powder and compound a similar preparation.

ü      Elimination of Problem-Causing Excipients - Medications can be formulated to eliminate unnecessary dyes, sugar, lactose, alcohol, and preservatives.

ü      Addition of Penetrant Enhancers- USP approved chemicals can enhance the absorption of topically applied medications.

ü      Dosage Modification - We can compound a medication that contains the most appropriate strength of medication to provide the needed benefit but minimize the risk of adverse effects. This can be particularly important for a patient with kidney failure or liver disease, or when the needed drug has a narrow therapeutic index.

ü      Prescriber-specific formulations - Often, physicians develop unique formulations that meet specific needs of their patient population, or acquire “tried and true’ formulas during medical training. We commonly prepare these customized medications.

Dermatologists, physicians, health care professionals and patients encounter numerous problems that may be helped with customized medications:

• Acne
• Warts and molluscum
• Psoriasis
• Fungal and viral infections
• Eczema
• Wrinkles and photoaged skin
• Rosacea
• Pigmentation abnormalities
• Sunburn
• Plant irritations (poison ivy, etc.)
• Hair loss
• Traumatized or diseased nails
• Fever blisters
• Head lice and Scabies
• Plantar warts
• Scarring and Keloids

When you have a problem that is difficult to treat, or if you are concerned about medication side-effects, call our professional compounding pharmacist. We can create customized formulations that contain the needed medications in the most appropriate vehicle to efficiently deliver the drug to the affected area.

Proper preparation is as important as drug selection. Our compounding pharmacy utilizes state-of-the-art equipment to create a formulation containing particles that are fine enough to be absorbed, and penetrant enhancers are added when appropriate. We offer a choice of bases to facilitate the proper extent of absorption.

Topical anesthetics

“The rapid proliferation of laser and cosmetic procedures has made adequate analgesia necessary for patient comfort and tolerability of optimal treatment settings necessary for maximal results.” The ideal topical anesthetic would have a rapid onset of activity and a high safety profile. Triple anesthetic gel containing permeation enhancers can provide effective cutaneous anesthesia as early as 15 minutes after application without occlusion.’ Use of a topical vitamin K cream after laser treatment can reduce the severity of bruising.

Chemical peels

Chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid, alone or in combination, are available for treatment of hyperpigmentations. Research has concluded that dermatologists should have a choice of formulations to satisfy individual patient needs.: A controlled chemical peel technique using 70% glycolic acid gel combined with 40%TCA has given consistently good results on the skin of the neck, chest, arms, hands, back, and other nonfacial skin.

Barrier creams

Barrier creams containing medications such as cholestyramine can be formulated to minimize development of contact dermatitis, as part of an incontinence skin care protocol, or to treat severe diaper rash.

Therapies for resistant problems

ü      We can compound customized formulations which contain numerous medications to provide a synergistic effect for treatment of resistant acne.

ü      Specific therapies are available for recalcitrant viral warts and molluscum contagiosum.

ü      Immunotherapy can be compounded to treat alopecia.

ü      Topical tamoxifen has potential as a novel therapeutic agent to treat abnormal dermal scarring.

ü      Topical treatment with sodium cromoglycate can be used as adjunctive or sole treatment for pyoderma gangrenosum.

ü      The natural antiviral 2-deoxy-D-glucose (2-DDG) inhibits the multiplication of herpes virus, and can be compounded in a variety of dosage forms.

ü      Patients with vitiligo have low catalase levels in their epidermis in association with high levels of hydrogen peroxide. Topical application of a UVB-activated pseudocatalase cream can successfully remove epidermal HO. resulting in a significant repigmentation.

Skin and wound care

Dry skin can be treated with topical application of moisturizers such as silicone or urea. We utilize specialized equipment, such as an ointment mill, that allows us to compound formulations containing much higher concentrations of active ingredients than can be prepared using traditional methods.

Decubitus ulcers, venous stasis and diabetic ulcers, traumatic wounds, and burns may heal more quickly if treated topically with phenytoin. Medications which improve capillary blood flow can be added to a compounded medication to enhance circulation at the wound margins and promote healing of the injured area, and topical anesthetics can be added to relieve pain.

Psoriasis

“For patients with localized psoriasis, and for many of those with moderate psoriasis as well, the mainstay of treatment is still topical therapy. The quality of life is greatly affected in such patients, and they often express high levels of dissatisfaction with current treatment options. Safe, convenient, and effective topical regimens, such as combination therapy with topical tacrolimus and salicylic acid, can be of great benefit in this large population.”

Methotrexate has been used as an effective systemic chemothera peutic drug for psoriasis by dermatologists for over 30 years, but oral methotrexate can cause a decrease in red and white blood cell and platelet counts and severe liver damage, diarrhea, and stomach irritation occur as dose-related drug-induced side effects. “Methotrexate 0.25% in a hydrophilic gel is well tolerated and significantly more effective than placebo as a patient-applied topical medication to treat psoriasis vulgaris.”

Cosmeceuticals

After a proper analysis reveals areas of dry, oily, or aging skin, we can provide the appropriate correction for each skin type in a cosmetic base containing the exfoliants, emollients, and micronutrients necessary for cellular repair. Antioxidants such as Alpha Lipoic Acid and Vitamin C Ester are vital to the energy production of skin cells and formation of collagen. Amino acids such as DMAE tone and add firmness to the skin, prevent age spots, and aid in healing the micro-scarring which causes wrinkles.

Cosmetically appealing preparations

Compounding pharmacists continue to develop new bases to improve both the aesthetic and therapeutic aspects of compounded medications. For example, anhydrous gels deliver medications which facilitate rapid absorption of the active ingredient into the skin and prolonged retention of the drug in the stratum corneum and epidermis, with minimal systemic transport of active drug. These cosmetically appealing gels are very stable and well accepted by patients.

We work together with prescribers and their patients to provide innovative solutions to challenging medical problems. Please contact our compounding pharmacist for more information or to discuss other “problem-solving” therapies.