All pharmacies were compounding pharmacies before the proliferation of chain drug stores, mega drug stores, and pharmacies in supermarkets, big box stores, and insurance company sponsored mail order pharmaceuticals. The privately owned pharmacies used to have a pharmacist who was known locally by name. Even the local doctors knew him.

Nearly all the human steroid hormones are made available by pharmaceutical manufacturing companies. They are packed in the form of powder and are stocked at the compounding pharmacy. All three estrogens, Estradiol, Estriol and Estrone, are commonly prescribed along with Progesterone, Testosterone and DHEA. Besides, Pregnenolone, melatonin, androstenedione, both thyroid hormones, T-4 and T-3 as well as freeze-dried pork thyroid are also available. Compounding pharmacists also formulate many medicines for dermatological and veterinary use.

There are some compounded products that are easier to formulate when compared with others. The time and effort invested by the pharmacist will be reflected in the price charged to the patient. As a general rule, the hormones themselves, and the fillers or creams, and gels are not that costly. It is the pharmacist’s time that is the main factor in the cost. Some things, like creams, may be just as easy to prepare in a large batch as a small batch. Buying a larger quantity at one time may save the patient a good sum of money. These are all important subjects for both patients and physicians to consider and discuss with their compounding pharmacist.

Let’s look at some of the medication forms available in the market, some of their uses, advantages and disadvantages.

Capsules and Tablets:

Any hormone that can be effectively when taken by mouth can be put in a capsule. Because the quantities of the various hormones are often very small, fillers can be used to fill up the extra space. Some patients may be allergic to, or react poorly to, certain kind of fillers. If such is the case, patients should discuss this with their pharmacist.

There are several types’ available including milk sugar and cellulose. The filler can be varied depending upon the patient’s sensitivity. Although Commercial products also use fillers but neither doctors nor patients have a choice in how they are formulated. Capsules and tablets are easy to consume, travel well, and offer a consistent & reliable dosage.

Oral dosage generally gives more consistent absorption from patient to patient than most other forms. In some cases, if appropriate, a physician can choose the dosage proportions of several different hormones or medications to combine them in a single capsule. This is not only convenient for the patient but also saves money. One disadvantage, however, is that the component parts cannot later be changed separately. It is better to give separate prescriptions until the dose is established and steady for that patient. You can then later combine the medications for convenience and cost saving.

Another minor disadvantage of capsules is that they can only be consumed as one. If you decide to raise or lower the dose, the patient can’t take half or three quarters of a capsule, or a little more than one, whereas in comparison, tablets can be cut and creams or gels can be used in slightly larger or smaller amounts.

Empty capsules are available in a variety of colours. This can be used to differentiate between various medications for ease of the patients tell their apart. At the time of prescribing capsules or tablets, when to administer, whether to consume it with food or on an empty stomach, and dosage frequency must be clearly specified.

There are very few manufacturers that make custom-made tablets. One advantage is that they can be divided for twice a day dosage for the price of one tablet. Multiple doses may be helpful when giving Estradiol or T-3 (triiodothyronine), both of which can be quite rapidly metabolized.

All food and medication taken by mouth, goes through the liver after it is absorbed in the intestine. This is known as the liver first pass effect. For example; Estrogen, has many effects on liver function. As a benefit, estrogen raises good cholesterol (HDL) and lowers bad cholesterol (LDL) when passed through the liver.

On the down side, that same estrogen raises triglycerides and increases blood-clotting reasons. The relative benefits and disadvantages must be considered at the time of deciding upon a route of administration.

Dermatology is the study of investigating, diagnosing, and treating skin problems of all kinds. Dermatology as a profession is a specialty focusing on various disorders and diseases of the skin, mucous membrane, hair, nails and numerous sexually transmitted diseases.

Dermatology is often practiced in combination with venereology, an area of expertise that diagnoses and treats sexually transmitted diseases, and phlebology, an area that deals with problems of the superficial venous system.

Dermatologists deal with a wide range of diseases including acne, warts, multiple inflammatory dermatomes, skin cancers, autoimmune diseases, occupational dermatomes and contact dermatitis, dealing with these diseases and disorders by way of different investigations and therapies.

Dermatology compounding is an ancient process of mixing drugs by a pharmacist or physician to fit the exclusive needs of a patient. For example, a patient allergic to the dyes used in a pill can take a doctor’s prescription for the necessary medicine to be compounded without the offending dye. Each compounded prescription is hand made from the bets quality chemicals and made by pharmacists that specialize in formulating drugs.

Of all the benefits that dermatology compounding offers, some are as follows
• Avoidance of dyes, preservative, fillers
• Palatable liquid medications
• Administrable dosage forms
• Avoidance of side effects
• Dose, dosage form, or medication not commercially available
• Combination or sustained release therapy to improve compliance
• Cost effective therapy

Here are a few problem solving ideas in cases where a commercially available product might fail to bring about the desired results:

• Problem Options
• Acne 4% Niacin amide gel Isotretinoin, Retinoic Acid Benzoyl peroxide, Sulfur, Resorcinol, Erythromycin, Clindamycin, each of the above medications can be compounded into a cream, lotion or gel.
• Onychomycosis Fluconazole, compounded into a nail polish with DMSO. The DMSO penetrates the nail bed, thus allowing the Fluconazole to work more directly at the site.
• Bleaching Agents Hydroquinone, Retinoic acid, each can be compounded into a cream, gel or lotion and in combination with lactic or glycolic acids.
• Eczema Corticosteroidshydrocortisone, Triamcinolone
• Fever Blisters Acyclovir lip balms, creams, lotions, Deoxy-d-glucose lip, balms, cream and lotions.
• Psoriasis Corticosteroids hydrocortisone, Triamcinolone, prednisone, Dexamethasone, Betamethasone, oral methotrexate, annthralin, coal tar, resorcinol, sulfur, salicylic acid, most can be compounded into a cream, lotion or gel.

However, any information that you get via books, internet or other media concerning diseases and disorders of the skin cannot be a substitute for a professional medical advice.

Only certified dermatologists have the medical training and experience needed to accurately diagnose the disease and decide on the most appropriate treatments for each patient.

There is an acute need for dermatology training in the world today. Something like 3 billion people living in more than 100 countries need basic care for their skin diseases. For the most part, skin diseases in the world can be detected and successfully treated by simple and economical means. All that is needed is trained personnel to provide skilled and well-read patient care – professional dermatologists.

Trained dermatologists more often than not combine several activities, ranging from seeing patients in public hospitals, clinics, in private practices acting as consultants to other specialists, teaching, and examining clinical or basic research.

Skin conditions such as psoriasis, dermatitis, eczema, infectious diseases, wounds, rosaceous and acne can all be easily treated with various compounded medications. Conventionally many of these conditions have been treated this way.

Examples of these traditional treatments are salicylic acid, menthol, phenol, coal tar solution, ichthammol, zinc oxide and dithranol. These still play an important role in treating these conditions. Also, there are many new medications that are not available as proprietary products that can be exceptionally helpful in treating skin conditions like tacrolimus, clobetasol propionate, hyaluronic acid and tretinoin.

The compounding pharmacist formulates therapies customized for the individual patient for a very wide range of dermatological conditions. Such skin conditions can mean not only physical discomfort but also personal awkwardness to those who suffer them.
Working closely with the dermatologist, expert compounding physicians prepare both therapeutic and cosmetic medications in a wide variety of formats depending on the requirements of the individual client. These include cosmetic creams, powders, and sprays for direct application to the skin, as well as a number of different oral formats from flavoured wafers to lollipops. Such medications can be applied in cases of Acne, Athlete’s foot, Diaper rash, Molluscum contagiosum, Moles and aging spots, Roseacea, Psoriasis, Warts, Pruritis. (more…)