Treatment of Skin Diseases                                                                                                                                                                                                                                                                          

Acne:

                                                                                                                  

Lesions, comedones and sometimes scars that may last throughout the adolescence are characteristics of acne. Clearing the lesions and preventing scarring can be accomplished by using topically a combination of different drying agents, antibiotics, anti-inflammatory and proliferative agents. These topical agents tend to have less than side effects than the orally or systemically administered dosage forms. And since they are localized, they deliver their desired effects directly to the affected areas. Below are examples of compounds used effectively for acne treatment:

                                                                                                                                                                              

Resorcinol 1% and Salicyclic Acid 3% Gel:

                                                                                                                                            

Application of the gel on the affected area will leave upon drying a thin film of the salicylic acid and resorcinol that act as a mild exfoliant.

      

Niacinamide 4% Gel:

         

Niacinamide is an anti-inflammatory agent that has been shown to be as effective in a 4% gel as clindamycin 1% but unlike clindamycin, niacinamide does not induce bacterial resistance.

    

Tetracycline Hydrochloride 2.25 mg/mL Topical Solution:

Mild acne vulgaris of puberty and early adolescence and the papular-pustular acne in adults can be treated with topical solution of tetracycline hydrochloride. Data is not available for the safety and efficacy of topical tetracycline for children under 11 years of age.

 

Lice/Scabies:

Many of the commercially available products are not effective in treating lice or scabies due to the existing organisms resistance to these products. Below are examples of preparations that a well trained compounding pharmacist can provide

 

Malathion 0.5% and 1% Lotion for Head Lice:

 

Extra care is taken in preparing this product and the procedure is performed under an exhaust hood due to fumes that may arise from the malathion powder. The limited availability of a commercial malathion product gives the compounding pharmacist the opportunity to deliver a customized strength for malathion which is normally compounded in a 0.5% lotion. A strength of 1% is desired if there is a concern with resistance. Malathion is effective against pests and safe for human consumption. A quantity of 10 mL of the lotion is thoroughly massaged into the hair and scalp and allowed to air dry for a period of 10-12 hours. The lotion can then be washed with an unconditioned shampoo and hot water. A nit comb can be used to remove as many ova as possible cleaning the comb with a toothbrush or a tissue after each stroke through the hair. If needed, the procedure can be repeated. This product can also be applied to the body in the case of body lice.

 

Natural Aromatic Head Lice Oil Combo:

 

For those patients who desire a natural remedy for lice, a combination of aromatic oils such as Rosemary, Eucalyptus, and Pennyrol oil combined in a vegetible oil such as olive oil can be compounded. The combo oil is applied to the hair and scalp  using a regular comb after a thorough washing of the hair with shampoo and hot water. A metal lice comb is then used to remove lice and nits from one section at a time with the metal comb being cleaned with a toothpick or a tissue after each stroke through the hair. The oil combo is then left for several hours, 8-10 hours or overnight and then washed with an unconditioned shampoo with hot water. The procedure can be repeated as needed. Avoid contact with eyes and wash thoroughly if the oil comes in contact with eyes. Needed amounts can be used to apply to affected area with body lice.

 

Benzyl Benzoate 10% Lotion:

 

Benzyl benzoate is an acaricide that is used as a scabicide and pediculoside. It is applied to head or body and left for 8 hours then rinsed off.

 

Ivermectin 1% Creme Rinse:

 

Similar to the other compounds mentioned above, the ivermectin Creme is applied to head or body, left for 8-10 hours and then rinsed off.

 

Psoriasis:

 

Affecting about 2% of the population in the United Sates, Psoriasis Vulgaris comes in different varying degrees of severity of a chronic inflammatory dermatoses. It appears that environmental or external factors such as cold and dry weather, photosensitivity, certain medications, or physical injuries to the skin play an important role in causing psoriasis in individuals predisposed with certain genetics. Hence, the argument exists for using immunosuppressive agents in treating the disease. Agents such as tacrolimus and cyclosporine can be incorporated in an ointment or a transdermal gel to increase the absorption through the skin thereby minimizing the side effects associated with the administration of they systemic route of these agents. The majority of therapies targeting psoriasis, however, consist of using the keratinizing process of the affected dermal-epidermal space of the skin. Agents such as coal tar solution and salicylic acid have long been used for psoriasis. Recent suggested treatments include the use of Vitamin D3 in a topical ointment. A recent study has shown that many patients with psoriasis have low levels of Vitamin D3 and in a double blind study, more than 90% of patients receiving Vitamin D3 showed significant improvement in their affected skin. Listed below are examples of compounded preparation proved to be effective in treating psoriasis:

 

Vitamin D3 15 mcg/gm Ointment

 

Heavy Moisturizing Psoriasis Ointment

This ointment consists of Vitamin E, Cocca Butter, White Petrolatum, White Paraffin and White Wax.

 

Coal Tar 3% Shampoo

 

Anthralin 1% Medication Stick

 

Fluocinolone Acetonide 0.01% in Oil

 

ASPC Scalp Lotion

The ingredients for ASPC Scalp Lotion include Anthralin, Salicylic Acid, and Coal Tar Solution.

 

Coal Tar 12% and Salicylic Acid 5% Scalp Lotion

 

Anthralin 1% and Coal Tar 1% Ointment

 

Calipotriene 0.003% Lotion

 

Cyclosporine 0.2% Topical Gel

 

Ketoprofen 0.3%, Cyclosporine 0.2%, and Clobetasol 0.01% in PLO Psoriasis Nail Gel