Compounded dermatology medications have great utility in treating skin conditions. In dermatology, the skin is both the diseased organ and a barrier to its own treatment. However, modern pharmacological advances have made the treatment of skin conditions much more effective.
Four commonly prescribed drug types in dermatology medication
Topical Steroids
Dermatologists commonly prescribe topical steroids. These topical drugs are FDA-approved, and some can even be purchased without a prescription. Low-dose hydrocortisone is available over the counter without a prescription. Topical steroids are commercially manufactured in a variety of potencies and come as ointments and creams. Care must be taken when using topical corticosteroids. The misuse of high potency steroids on the face may cause dermatological atrophy and opportunistic bacterial infections.
When selecting which drug to prescribe, the prescriber must take into account the area afflicted. The skin has varying degrees of sensitivity and thickness depending on anatomical location. For example, the face, back of the knees, and the inside of elbows have fragile and sensitive skin.
Topical Calcineurin Inhibitors
Topical calcineurin inhibitors exert their effect on the skin by inhibiting inflammation. This class of medications acts on your immune system to decrease the intensity of the immune reaction that causes eczema symptoms. Tacrolimus ointment is the most commonly prescribed calcineurin inhibitor.
Systemic Steroids
In addition to topical steroids, systemic corticosteroid therapy is often used when treating dermatological disorders. Systemic steroids are commonly taken by mouth as a tablet. These drugs exert their effect by inhibiting the immune system at a much broader level than topical steroids.
Long-term treatment with corticosteroid therapy can cause a host of adverse effects. For example, increased blood glucose, increased appetite, predisposition to stomach ulcer formation, muscle wasting, insomnia, and rapid mood changes are examples of the side effects of long-term corticosteroid therapy. Therefore in most cases, these drugs are used short-term.
Anti-Histamines
Anti – Histamines are used to treat itching that may accompany dermatological conditions. Allergic reactions, poison ivy, and insect bite reactions are common indications for topical anti-histamines. It is important to note that oral-systemic anti-histamines can also play a role in allergic reaction management.
What new dermatology medications are prescribed for skin issues?
Abrocitinib is Pfizer’s new oral Janus kinase (JAK) 1 inhibitor. JAK1 is a critical protein needed for the propagation of the immune response seen in eczema patients. It is dosed once daily and indicated for moderate to severe atopic dermatitis.
Bimekizumab is a monoclonal IgG1 antibody that inhibits interleukin-17A and interleukin-17F, reducing the immune response seen in plaque psoriasis.
Deucravacitinib is Bristol-Myers Squibb’s oral TYK2 inhibitor. It works by inhibiting the signaling of interleukin (IL)-12, IL-23, and Type 1 interferon (INF). These inflammatory cytokines are responsible for psoriasis flares.
Benefits of Compounded Dermatology Medication
Compounded topical medications can be custom designed to provide optimal drug absorption and eliminate unnecessary preservatives or allergens. In addition, commercially available steroids are provided in a handful of strengths. Our compounding pharmacy can work directly with your physician to formulate a product that delivers the precise amount of drug, preventing you from being exposed to excess corticosteroid, which in turn reduces the potential for side effects.
The vehicle in which a drug is delivered can make a huge difference in its effectiveness. We can take a medication that is only commercially available as a cream, and create a different base with the same active ingredient. As a result, we can produce creams, ointments, gels, topical sprays and foams, medicated shampoos, and more.
To promote more drug absorption per unit of time, creating a concentration gradient is beneficial. This is done by increasing the amount of drug present on the skin’s surface, which then moves down the gradient via diffusion. Compounding pharmacists are experts in the design of drug delivery systems and can use this principle to achieve optimal drug absorption.
The skin is a natural barrier that must be overcome during drug delivery. The use of an occlusive dressing increases the penetration of corticosteroids through the skin. A compounding pharmacy can make a steroid impregnated dressing for use in certain situations.
Our pharmacy team invites you to ask our pharmacists any questions you may have about skin issues.
Related Conditions & Treatments
Eczema (atopic dermatitis)
Over 10% of the U.S. population has eczema. Another name for this condition is atopic dermatitis. Eczema is a chronic condition in which patients experience relapses of skin irritation. Possible eczema triggers include viral infections, food allergens, and aeroallergens.
The basic principles of treating eczema include controlling the itch, healing the skin, and preventing further flares. Topical corticosteroids are the primary drugs used when treating eczema symptoms. However, each patient is unique and will have to see what drug and formulations work best for symptom control. This highlights the importance of using a compounding pharmacy to formulate personal treatments.
Contact Dermatitis
Contact dermatitis results from direct physical contact with an allergen and the skin. Contact dermatitis treatment consists of anti-histamines (topical or systemic) followed by identifying and preventing exposure to the allergen.
Psoriasis
Psoriasis is a chronic inflammatory skin disorder characterized by recurrent thickened, erythematous, and scaling plaques. Many patients with psoriasis report worsening of symptoms in cold weather and outbreaks after viral upper respiratory infections.
Topical corticosteroids are the gold standard of psoriasis treatment. Corticosteroid ointments are used over creams due to their increased potency. In addition, topical vitamin D3 analogs such as calcipotriene can be used to inhibit keratinocyte proliferation.
Skin Conditions Resources
The American Academy of Dermatology Association has an online-based resource center for both Psoriasis and Eczema patients.
Your pharmacist is one of the most accessible and knowledgeable resources you can access for free! So please don’t hesitate to reach out to your pharmacist with any questions about your dermatological medications!