Dermatology

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

Int J Dermatol 1995 Jun;34(6):434-7. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris..

J Dermatol 1996 Apr;23(4):243-6. Topical spironolactone reduces sebum secretion rates in young adults..

Various synergistic combinations are used for antifungal therapy. Research points to the practicality “of using ibuprofen, alone or in combination with azoles, in the treatment of candidosis, particularly when applied topically, taking advantage of the drug’s antifungal and anti-inflammatory properties.”

J Med Microbiol 2000 Sep;49(9):831-40. Antifungal activity of ibuprofen alone and in combination with fluconazole against Candida species..

Chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid, either alone or in combination, are effective therapy for diffuse melasma and localized hyperpigmentations (lentigo).

Dermatol Surg 1999 Jun;25(6):450-4. The use of chemical peelings in the treatment of different cutaneous hyperpigmentations..

Ann Pharmacother. 1996 Sep;30(9):954-6.. Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant..

Dis Colon Rectum. 1987 Feb;30(2):106-7.. Cholestyramine ointment in the treatment of perianal skin irritation following ileoanal anastomosis..

Concerns about emerging resistance and the potential harm of using permethrins have prompted a search for effective pediculicidal therapies that are not harmful to children with repeated use. An herbal formulation has been shown to be effective for head lice. Ivermectin can also be compounded for topical application or as an oral dose titrated for each patient for the treatment of head lice and scabies.

Clin Exp Dermatol. 2002 Jun;27(4):264-7.. Treatment of 18 children with scabies or cutaneous larva migrans using ivermectin..

Trop Med Parasitol. 1994 Sep;45(3):253-4.. Efficacy of ivermectin for the treatment of head lice (Pediculosis capitis)..

J Dermatol. 2001 Sep;28(9):481-4.. Oral ivermectin in scabies patients: a comparison with 1% topical lindane lotion..

Isr Med Assoc J. 2002 Oct;4(10):790-3.. The in vivo pediculicidal efficacy of a natural remedy..

The following study found that 5% KOH aqueous solution proved to be as effective and less irritating when compared to the 10% KOH solution. This trial also emphasizes the effectiveness of topical KOH in the treatment of molluscum contagiosum, sparing affected children from more aggressive physical modalities of treatment.

Pediatr Dermatol. 2000 Nov-Dec;17(6):495.. Evaluation of the effectiveness of 5% potassium hydroxide for the treatment of molluscum contagiosum..

Although surgical excision is the most popular method for removing nails, the use of concentrated urea plasters applied under occlusion may be superior. The use of urea plasters has inherent advantages – they are inexpensive, several nails can be treated in one session, and the procedure is essentially painless. Various synergistic combinations and topical medications with penetrant enhancers can be compounded for antifungal therapy. Topical medications usually have a lower adverse drug-reaction profile than systemic medications.

Cutis. 1980 Jun;25(6):609-12.. Urea ointment in the nonsurgical avulsion of nail dystrophies--a reappraisal..

Cutis. 1980 Apr;25(4):397, 405.. Combination urea and salicyclic acid ointment nail avulsion in nondystrophic nails: a follow-up observation..

Management of onychomycosis, a fungal infection of the fingernails and toenails, usually consists of systemic antifungal medications, topical therapy (e.g., urea ointment, desiccating solutions, keratolytics, vital dyes), or surgical intervention (e.g., nail plate avulsion, laser therapy). Topical prescription antifungal preparations, containing the active ingredient of your choice, may be less likely to cause the serious systemic side effects that can occur with oral antifungal therapy and can provide a more economical alternative, as lower doses are needed when the medication is applied topically at the site. Penetrant enhancers can be included in the preparation to improve the effectiveness of topical antifungals.

Trop Med Int Health. 1999 Apr;4(4):284-7.. Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream..

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 H2O2 resulting in a remarkable repigmentation.

J Investig Dermatol Symp Proc. 1999 Sep;4(1):91-6.. In vivo and in vitro evidence for hydrogen peroxide (H2O2) accumulation in the epidermis of patients with vitiligo and its successful removal by a UVB-activated pseudocatalase..

Phys Ther. 2002 Dec;82(12):1184-91.. Treatment of plantar verrucae using 2% sodium salicylate iontophoresis..

Clin Exp Dermatol. 2003 Jan;28(1):61-3.. Topical application of NADH for the treatment of rosacea and contact dermatitis..

Br J Plast Surg. 1998 Sep;51(6):462-9.. Topical tamoxifen--a potential therapeutic regime in treating excessive dermal scarring?.

Topical anesthesia is needed for common procedures such as suturing, wound cleaning, and injection administration. The ideal topical anesthetic would provide complete anesthesia following a simple pain-free application, not contain narcotics or controlled substances, and have an excellent safety profile. The combination of topical anesthetics lidocaine and tetracaine and the vasoconstrictor epinephrine has been used successfully for anesthesia prior to suturing linear scalp and facial lacerations in children. A triple-anesthetic gel containing benzocaine, lidocaine, and tetracaine (“BLT”) has also been reported to be effective when applied prior to laser and cosmetic procedures. Convenience of application without need for occlusion is an advantage of these topical anesthetics.

Pediatrics. 1995 Feb;95(2):255-8.. Lidocaine adrenaline tetracaine gel versus tetracaine adrenaline cocaine gel for topical anesthesia in linear scalp and facial lacerations in children aged 5 to 17 years..

Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoageing of facial skin.

Br J Dermatol. 2003 Oct;149(4):841-9.. Randomized, placebo-controlled, double blind study on the clinical efficacy of a cream containing 5% alpha-lipoic acid related to photoageing of facial skin..

Declining estrogen levels are associated with a variety of cutaneous changes, many of which can be reversed or improved by topical or systemic estrogen supplementation. Studies of postmenopausal women indicate that estrogen deprivation is associated with declining dermal collagen content, diminished elasticity and skin strength, loss of moisture in the skin, epidermal thinning, atrophy, fine wrinkling, and impaired wound healing. Keratinocytes, Langerhans’ cells, melanocytes, sebaceous glands, collagen content and the synthesis of hyaluronic acid are under hormonal influence. Estrogen may attenuate inflammation in psoriatic lesions. Alone or together with progesterone, estrogen prevents or reverses skin atrophy, dryness and wrinkles associated with chronological or photo-aging. Estrogen and progesterone stimulate proliferation of keratinocytes while estrogen suppresses apoptosis and thus prevents epidermal atrophy. Estrogen maintains skin moisture by increasing acid mucopolysaccharide or hyaluronic acid levels in the dermis, and accelerates cutaneous wound healing.

Low estrogen levels that accompany menopause exacerbate the deleterious effects of both intrinsic and environmental aging. Estrogens clearly have a key role in skin aging homeostasis as evidenced by the accelerated decline in skin appearance seen in the perimenopausal years.

At Yale University School of Medicine, the effects of long-term hormone replacement therapy (HRT) on skin rigidity and wrinkling at 11 facial locations was assessed using the Lemperle scale by a plastic surgeon who was blinded to HRT use. Skin rigidity at the cheek and forehead was measured with a durometer. Demographics including age, race, sun exposure, sunscreen use, tobacco use, and skin type were similar. Rigidity was significantly decreased in HRT users compared to nonusers at both the cheek and forehead. Average wrinkle scores were lower in hormone users than in nonhormone users. The study concluded that long-term postmenopausal HRT users have more elastic skin and less severe wrinkling than women who never used HRT, suggesting that hormone therapy may have cosmetic benefits.

In another study, the dermal collagen of 15 postmenopausal women who had received systemic estrogen replacement was analyzed before and after using a topical 0.01% estrogen treatment. Epithelial and dermal thickness improved after topical estrogen therapy. Facial skin collagen significantly increased after 16 weeks of treatment. Systemic estrogen levels did not significantly increase after topical therapy.

In the following study, the effects of topical 0.01% estradiol and 0.3% estriol compounds were measured in preclimacteric women with skin aging symptoms. After treatment for 6 months, elasticity and firmness of the skin had markedly improved; wrinkle depth and pore sizes had decreased by 61 to 100%; skin moisture had increased; and wrinkle depth decreased significantly.

Int J Dermatol. 1996 Sep;35(9):669-74.. Treatment of skin aging with topical estrogens..

Eur J Dermatol. 2004 Jul-Aug;14(4):238-46.. The efficacy and safety of low-dose diclofenac sodium 0.1% gel for the symptomatic relief of pain and erythema associated with superficial natural sunburn..

Arch Dermatol. 2005 Jan;141(1):43-6.. Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment..

J Cutan Med Surg. 2001 Jul-Aug;5(4):299-302. Epub 2001 Jul 18.. Management of psoriasis vulgaris with methotrexate 0.25% in a hydrophilic gel: a placebo-controlled, double-blind study..

J Dermatol. 2004 Oct;31(10):798-801.. Topical 0.25% methotrexate gel in a hydrogel base for palmoplantar psoriasis..

Int J Dermatol. 2003 Feb;42(2):157-9.. Topical methotrexate delivered by iontophoresis in the treatment of recalcitrant psoriais--a case report..

Pseudocatalase Cream

Vitiligo is a spontaneous irregular depigmentation of skin. Patients with vitiligo have low catalase levels in their epidermis with high levels of hydrogen peroxide. Pseudocatalase cream is an externally applied UVB-activated product that can lead to recovery of the oxidative damage in the epidermis and remarkable repigmentation.

Skin Pharmacol Appl Skin Physiol. 1999 May-Jun;12(3):132-8.. Successful treatment of oxidative stress in vitiligo..

J Pathol. 2000 Aug;191(4):407-16.. Melanocytes are not absent in lesional skin of long duration vitiligo..

J Investig Dermatol Symp Proc. 1999 Sep;4(1):91-6.. In vivo and in vitro evidence for hydrogen peroxide (H2O2) accumulation in the epidermis of patients with vitiligo and its successful removal by a UVB-activated pseudocatalase..

Dermatology. 1995;190(3):223-9.. Treatment of vitiligo with a topical application of pseudocatalase and calcium in combination with short-term UVB exposure: a case study on 33 patients..

Topical Phenylalanine

Melanocytes are still present in long-standing (> 25 years) depigmented skin of patients with vitiligo. L-phenylalanine uptake and turnover in the pigment forming melanocytes is vital for initiation of melanogenesis.

Arch Dermatol. 1999 Feb;135(2):216-7.. Treatment of vitiligo with oral and topical phenylalanine: 6 years of experience..

J Drugs Dermatol. 2002 Sep;1(2):127-31.. Oral and topical L-phenylalanine, clobetasol propionate, and UVA/sunlight--a new study for the treatment of vitiligo..

Mol Genet Metab. 2005 Dec;86 Suppl 1:S27-33. Epub 2005 Sep 6.. Decreased phenylalanine uptake and turnover in patients with vitiligo..

Cantharidin in a collodion vehicle has been used by dermatologists as a treatment for molluscum contagiosum and warts since the 1950s. Cantharidin lost FDA approval in 1962 because its manufacturers failed to submit data attesting to cantharidin’s efficacy. However, in 1999, the FDA included cantharidin on its “Bulk Substances List” of drugs which although not available as commercial products, were approved for compounding on a customized basis for individual patients.

Because of cantharidin’s potential for toxicity, the FDA has proposed that cantharidin should be limited to “topical use in the professional office setting only.” Severe blistering can result from improper use, and ingestion, especially by children, can be fatal. Treatment of mucous membranes is contraindicated and placement of cantharidin near the eyes and eyelids should be avoided to prevent scleral erosion.

Caution: The treatment of plantar warts with cantharidin is NOT recommended and may have a higher rate of significant complications including lymphangitis and refractory lymphedema.

Arch Dermatol. 2001 Oct;137(10):1357-60.. Cantharidin revisited: a blistering defense of an ancient medicine..

J Am Acad Dermatol. 2000 Sep;43(3):503-7.. Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients..

Squaric Acid Dibutylester (SADBE) for Cutaneous Warts in Children

Warts are a common pediatric skin infection and clearance may be enhanced by contact sensitizers, such as squaric acid dibutylester (SADBE). Contact immunotherapy with SADBE is relatively safe and an effective alternative in the management of multiple and resistant cutaneous warts in children.

J Am Acad Dermatol. 2000 May;42(5 Pt 1):803-8.. Squaric acid immunotherapy for warts in children..

Pediatr Dermatol. 2000 Jul-Aug;17(4):315-8.. Use of squaric acid dibutylester (SADBE) for cutaneous warts in children..

J Am Acad Dermatol. 1999 Oct;41(4):595-9.. Contact immunotherapy with squaric acid dibutylester for the treatment of recalcitrant warts..