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Thank you for entrusting in the compounding services at MD Custom Rx to help meet the unique medication needs of your patients. We are excited to share with you our monthly newsletter and look forward to continuing to be your medication problem solvers. Please don't ever hesitate to let us know how we can be of further assistance to you and your practice.
Sincerely,
John, Dan and Monica |
RECENT ADVANCEMENTS IN TOPICAL FORMULATIONS
have resulted in preparations that may reduce inflammation and scar tissue, and can also help with healing of wounds, burns, and skin cuts or ulcerations. Depending on the problem, a base can be selected that will form a protective film over the skin, maintain a moist environment to optimize healing, or that contains glycosides and flavonoids with potential germicidal and anti-inflammatory properties. Medications can be added to novel proprietary bases to help reduce scar tissue, keloids, or stretch marks (which can result from sudden weight gain or weight loss, as well as pregnancy).
To the most appropriate base, our compounding pharmacy can add medications such as tamoxifen which has been documented to be beneficial in treating scars, anti-inflammatories/corticosteroids, antibiotics, topical anesthetics, antioxidants such as EGCg, and tranilast.
Tranilast is a versatile mast cell stabilizer that has been shown to be useful in treating allergic rhinitis and allergic conjunctivitis, atopic dermatitis, eczema, keloids and hypertrophic scars. Tranilast inhibits the release of chemical mediators such as histamine, as well as inhibiting collagen synthesis through interference with Tissue Growth Factor beta activity.1
Other dermatological problems such as atopic dermatitis and eczema can be treated with tranilast 2-10% in a vanishing cream base.2 Patients with psoriasis may also benefit from the use of topical tranilast.3
Because tranilast is metabolized in the liver, periodic liver function tests should be done with long-term therapy. Tranilast is contraindicated for use during pregnancy and in patients with acute asthma or hypersensitivity to the drug. It should be used with caution in patients with renal insufficiency, liver disease, or during breastfeeding. Mild side effects can occur, including headache, drowsiness, insomnia, dizziness, skin rashes, pruritis, and malaise.4 Tranilast is not commercially available in the United States but is available by prescription from our compounding pharmacy.
PracaSil-Plus is a distinctive and elegant topical anhydrous silicone base from PCCA that can be used alone or with various APIs. We have found PracaSil-Plus to be an ideal choice for use in preparations used on all types of scar tissue, including new scars, old scars, surgical scars, keloids, stretch marks or any skin conditions that would benefit from barrier protection.
PracaSil-Plus is a soothing, emollient base with mild penetration. It contains Pracaxi oil which is used by the indigenous people of the Amazon rain forest for its potential healing properties. Pracaxi oil is rich in organic acids with antioxidant, antibacterial and antifungal properties. In the Amazon, Pracaxi oil has been used for generations for treatment of skin spots, severe acne (and scars), and is useful for psoriasis and rosacea.
EXAMPLES of FORMULATIONS that can be compounded using PracaSil-Plus as a base include:
- Collagenase 350 U/Gm/Hyaluronidase 250 U/Gm Compound Topical Gel
- Betamethasone Valerate 0.1%/Tranilast 1% Topical Gel
- Tamoxifen Citrate 0.1%/Tranilast 1%/Caffeine Citrated 0.1%/Lipoic Acid 0.5% Topical
- EGCg 1%/Dimethyl Sulfone 2%/Tranilast 1%/Ascorbic Acid 2% Topical Gel
- EGCg 1%/Dimethyl Sulfone 5%/Ascorbic Acid 2%/Caffeine 1% Topical Gel
Occlusaderm i s a new base designed by PCCA to be an excellent film former with superb adhesive properties. Occlusaderm provides occlusion, which enhances drug absorption and penetration, and also increases skin moisture. It can be used alone or with a variety of drugs to treat disease states that may benefit from occlusion. EXAMPLES of FORMULATIONS that can be compounded using OcclusadermT as a base include: - Lidocaine 7%/Tetracaine 7% Topical
- Gabapentin 10%/Ketoprofen 5%/Amitriptyline HCl 2%/Lidocaine 1% Topical. Tretinoin 5% Topical Peel
- Tretinoin 0.05% Topical Cream
- Benzoyl Peroxide 5% Topical Lotion
- Metronidazole 1%/Niacinamide 4% Topical
- Ketoprofen 2%/Lidocaine 2%/Aloe Vera 0.2%/Phenytoin 2% Topical Cream
- Zinc Pyrithione 0.2%/Clobetasol Propionate 0.05%/Cyanocobalamin 0.07% Topical Cream
- Hydroquinone 8% Topical
- Sodium Hyaluronate 0.1% Topical
Spira-Wash Gel is a remarkably adherent base designed for a variety of different applications, including anti-infection treatments of the skin, dermatology, occlusive needs, wound care and topical humectants. It contains organic Meadowsweet Extract which potentially has germicidal, anti-inflammatory and healing properties, thus making it a good choice for wounds, ulcers, burns, sores, and cuts. Spira-WashT Gel maintains a moist environment at the application site which allows for optimal healing and is a water washable base, which is very important in wound care since wounds need to be cleaned/debrided on a regular basis. This also allows the possibility of increasing macrophage and fibroblast activity, re-epithelialization and the production of collagen. Pain is decreased as well by maintaining this moist environment.
Spira-Wash Gel contains polyethylene glycol and should not be used in conditions where absorption of large quantities is possible, for example on extensive burn areas and large surface areas, especially if there is evidence of moderate or severe renal impairment.
EXAMPLES of FORMULATIONS that can be compounded using
Spira-WashT Gel as a base include:
- Mupirocin 5%/Itraconazole 5%/Fluticasone Propionate 1%/Urea 40%
- Vancomycin HCl 5%/Mupirocin 5%
- Phenytoin 5%/Misoprostol 0.0024%/Nifedipine 2%
- Misoprostol 0.0024%/Phenytoin 5%/Gentamicin 0.2%
- Ketoprofen 2%/Lidocaine 2%/Misoprostol 0.0024%/Phenytoin 2%/Aloe Vera 0.2%
- Misoprostol 0.0024%/Metronidazole 2%/Lidocaine HCl 2%
- Gentamicin 1mg/Gm, Clindamycin 1mg/Gm, Polymyxin 2,000 U/Gm
- Morphine Sulfate 1%
In addition to medications for treatment of wounds or scars, we can customize dermatologic medications such as numbing creams, skin-whitening formulas, facial masks and acne preparations. Ask our compounding pharmacist for more information.
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