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Dermatology Compounding

DERMATOLOGY COMPOUNDING

At Agewell we customize each prescription formulation specifically to each patients' individual requirements.  We strive to provide the utmost in customer care on every order.  Please call us with any questions pertaining to your compounding request, we are here to discuss any questions or concerns you may have pertaining to your prescription.

 

Compounding medications for dermatological diseases allows for:

 

  • Unique delivery vehicles to be utilized (i.e. topical cream, scalp lotion, nail lacquer); which makes administering the medication easier, more pleasant, and potentially more effective

 

  • Medicines to be concentrated based on individual need, which maximizes therapeutic outcomes while reducing side effects  

 

  • Multiple medications, that have been shown to have modest effects individually, to be combined to form a more potent customized medication. This may speed the healing process and save patients valuable time and money, eliminating needlessly switching from one therapy to the next

ACNE:

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.

In order to access the PubMed abstract of this article, visit this website link.
 

 

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

 

In order to access the PubMed abstract of this article, visit this website link.
 

ATHLETES FOOT:

There are various synergistic combinations which 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.

In order to access the PubMed abstract of this article, visit this website link.
 

 

CHEMICAL PEELS:

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.

In order to access the PubMed abstract of this article, visit this website link.

 

DIAPER RASH / INCONTINENCE:

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

In order to access the PubMed abstract of this article, visit this website link.
 

 

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

In order to access the PubMed abstract of this article, visit this website link.
 

HEAD LICE AND SCABIES:

There are 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
The below mentioned article describes the treatment of 18 children with scabies or cutaneous larva migrans using ivermectin.

In order to access the PubMed abstract of this article, visit this website link.


Twenty six male and female patients aged 5 to 17 years had head lice infestation confirmed by eggs presence and received treatments with a single 200 microgram/kg oral dose of. At day 14 after treatment, 20 had responded to the treatment (77%), and 6 patients (23%) presented with a complete disappearance of eggs and all clinical symptoms. At day 28, 7 patients appeared clear of infestation (27%), but 4 of the 6 patients with no eggs at day 14 presented with signs of reinfestation. This study suggests that ivermectin is a promising treatment of head lice, and a second dose at day 10 may be appropriate.

Trop Med Parasitol 1994 Sep;45(3):253-4
The below mentioned article depicts the efficacy of ivermectin for the treatment of head lice (Pediculosis capitis).

In order to access the PubMed abstract of this article, visit this website link.
 

 

 Two hundred scabies patients were randomly allocated to receive either oral ivermectin in a single dose of 200 micrograms/kg body weight, or 1% lindane lotion for topical application overnight. Patients were assessed after 48 hours, two weeks and four weeks. After a period of four weeks, 82.6% of the patients in the ivermectin group showed marked improvement; only 44.44% of the patients in the lindane group showed a similar response. Oral ivermectin is easy to administer as a single oral dose, induces an early and effective improvement in signs and symptoms, and compliance is accordingly increased.

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

In order to access the PubMed abstract of this article, visit this website link.

 

 

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

In order to access the PubMed abstract of this article, visit this website link.
 

MOLLUSCUM CONTAGIOSUM:

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.

In order to access the PubMed abstract of this article, visit this website link.
 

NAIL INFECTION / REMOVAL:

Treatment of Fingernail Lichen Planus
 
Nail lichen planus most commonly occurs during the fifth and sixth decade of life and can be notoriously recalcitrant to many forms of treatment. Prevost and English of the University of Pittsburgh Department of Dermatology reported a case of successful treatment of destructive inflammatory lichen planus of the nails with combined topical therapy of tazarotene gel and clobetasol gel, without the occurrence of potential adverse affects of systemic treatments.
 
J Drugs Dermatol. 2007 Feb;6(2):202-4.
Palliative treatment of fingernail lichen planus.

In order to access the PubMed abstract of this article, visit this website link.


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.

In order to access the PubMed abstract of this article, visit this website link.
 

 

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

In order to access the PubMed abstract of this article, visit this website link.
 

JAMA 1979 Apr 13;241(15):1559, 1563
Urea plasters alternative to surgery for nail removal.
PMID: 430701 (No abstract available)

Clin Exp Dermatol 1982 May;7(3):273-6
The treatment of fungus and yeast infections of nails by the method of "chemical removal".
PMID: 7105479 (No abstract available)

 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.

In order to access the PubMed abstract of this article, visit this website link.

PIGMENTATION ABNORMALITIES:

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.

In order to access the PubMed abstract of this article, visit this website link.

PLANTAR WARTS / WARTS:

Topical 5-fluorouracil (5-FU) 5% with tape occlusion produced complete eradication of all plantar warts within 12 weeks of treatment in 19 of 20 patients. It was concluded that use of topical 5% 5-fluorouracil cream for plantar warts is safe, efficacious, and accepted by the patient.
 
J Drugs Dermatol. 2006 May;5(5):418-24.
Topical 5% 5-fluorouracil cream in the treatment of plantar warts: a prospective, randomized, and controlled clinical study.

In order to access the PubMed abstract of this article, visit this website link.
 

A medical record review was conducted by the Podiatry Division, Department of Orthopedics, Cabrini Medical Center, New York, NY to determine the clinical outcome and average time to resolution of verruca plantaris (plantar warts) in 20 patients treated with twice-daily applications of topical fluorouracil (5-FU) combined with topical 17% and 40% salicylic acid. Twice-daily application of topical fluorouracil and salicylic acid is a safe and effective treatment for verruca plantaris.

J Am Podiatr Med Assoc. 2005 Jul-Aug;95(4):366-9.
Treatment of verruca plantaris with a combination of topical fluorouracil and salicylic acid.

In order to access the PubMed abstract of this article, visit this website link.
 

 

 

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

In order to access the PubMed abstract of this article, visit this website link.
 

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;137:1357-1360
Cantharidin revisited: a blistering defense of an ancient medicine.

In order to access the PubMed abstract of this article, visit this website link.
 

J Am Acad Dermatol. 2000;43:503-507
Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients.

In order to access the PubMed abstract of this article, visit this website link.
 

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.

In order to access the PubMed abstract of this article, visit this website link.
 

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

In order to access the PubMed abstract of this article, visit this website link.

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

In order to access the PubMed abstract of this article, visit this website link.
 

ROSACEA:

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

In order to access the PubMed abstract of this article, visit this website link.
 

SCARRING AND KELOIDS:

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

In order to access the PubMed abstract of this article, visit this website link.
 

 

TOPICAL ANESTHETICS:

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.

The following article concludes: "LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) worked as well as TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children."

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.

In order to access the PubMed abstract of this article, visit this website link.
 

The following article reported that a triple-anesthetic gel containing benzocaine, lidocaine, and tetracaine ("BLT") applied prior to treatment with a 532-nm KTP laser resulted in significantly lower pain scores than with 3 other topical anesthetics at 15, 30, 45, and 60 minutes after application.

Cosmetic Dermatology 2003 Apr;16(4):35-7
Topical Triple-Anesthetic Gel Compared With 3 Topical Anesthetics

TOPICAL THERAPY WITH 5-Flourourcil:

G. Thomas Jansen, M.D.

University of Arkansas Medical Center, Little Rock Veterans Administration Hospital, Little Rock, Arkansas

 

Actinic keratoses are unsightly and may be precancerous. Solitary or localized lesions respond adequately to many forms of treatment. However, widespread multiple actinic keratoses can best be treated with topical 5-fluorouracil. The exact mode of action is not known, but we can presume it is related to the clearly established effect of this drug upon RNA and DNA synthesis. This treatment is almost ideal, since it usually destroys the keratoses selectively, without significant alteration in normal skin. A 1 or 2 percent solution is made by diluting the 10 ml ampule with propylene glycol. This liquid is applied two times daily to the involved areas for a 2-4 week period. Lesions on the face and neck respond more quickly than those of the hands and arms. A brisk, painful, inflammatory reaction at the site of the keratoses is anticipated and used as an indicator of the end point of treatment. Once treatment is discontinued, the erythema usually subsides in 2 weeks and the skin becomes smooth and free of keratoses. Not all keratoses respond, and untoward reactions such as phototoxicity, irritation of the mucous membranes, contact sensitivity, and alteration of pigmentation can occur. Although resolution of the keratoses persists for years, should they return reapplication is usually effective again.

 At agewell, we can compound the following 5fu combination:

Fluorouracil 5% / Salicylic Acid 30% / Retinoic Acid 0.1% Gel

SUN PROTECTION / PHOTOAGED SKIN / WRINKLES:

Topically applied antioxidants exert their benefits by offering protection from damaging free radicals produced when skin is exposed to ultraviolet light or allowed to age naturally. Appropriate formulation and use which is supervised by a knowledgeable healthcare professional will maximize the benefits while minimizing any potential side effects of these therapies.
 
Biofactors 1999;9(2-4):371-8 
Coenzyme Q10, a cutaneous antioxidant and energizer.

In order to access the PubMed abstract of this article, visit this website link.
Coenzyme Q10 (ubiquinone, CoQ10) is an important antioxidant that is taken to strengthen immune and cardiac function. The processes of aging and photoaging of the skin (due to sunlight) are associated with an increase in cellular oxidation, which may occur as the body’s own levels of CoQ10 decline. A reduction in wrinkle depth was shown following topical application of CoQ10 0.3%, and results indicated that CoQ10 has the efficacy to prevent many of the detrimental effects of photoaging. Wrinkles around the region of the eyes (“crow’s feet”) may be reduced by long-term application of CoQ10.
 
Z Gerontol Geriatr 1999 Apr;32(2):83-8
Modulation of oxidative stresses in human aging skin

In order to access the PubMed abstract of this article, visit this website link.
Vitamin C has been incorporated into a variety of cosmeceuticals designed to protect and rejuvenate photoaged skin. Ascorbyl Palmitate (Vitamin C Ester) is a lipid soluble, neutral pH, non-acidic (thus, non-irritating and non-stinging) form of Vitamin C which can reach cells within the skin rapidly in amounts greater than can be achieved by water soluble Vitamin C (L-Ascorbic Acid).

Dermatol Surg. 2005 Jul;31(7 Pt 2):814-7
Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions.

In order to access the PubMed abstract of this article, visit this website link.
 

Alpha Lipoic Acid (ALA) is a powerful antioxidant and scavenger with anti-inflammatory properties that promotes optimum efficiency for production of energy and removal of intracellular waste products, essential for cellular healing and elimination of wrinkles and facial scars. Twelve weeks of treatment with a cream containing 5% ALA improves clinical characteristics related to photoaging 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.

In order to access the PubMed abstract of this article, visit this website link.
 

Topical niacinamide 5% (vitamin B3) reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin.
  
Int J Cosmet Sci. 2004 Oct;26(5):231-8.
Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin.

In order to access the PubMed abstract of this article, visit this website link.
Topical application of 0.01% estradiol and 0.3% estriol markedly improved elasticity and firmness of the skin, substantially decreased  pore sizes, increased skin moisture, and decreased wrinkle depth.
 
Eur J Obstet Gynecol Reprod Biol. 2007 Feb;130(2):202-5.
Effects of topical estradiol on the facial skin collagen of postmenopausal women under oral hormone therapy: a pilot study.

In order to access the PubMed abstract of this article, visit this website link.
 

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

In order to access the PubMed abstract of this article, visit this website link.
Topical 2% progesterone increases elasticity and firmness in the skin of peri- and postmenopausal women.
 
Br J Dermatol. 2005 Sep;153(3):626-34.
Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study.

In order to access the PubMed abstract of this article, visit this website link.
 

DMAE (2-dimethylaminoethanol, deanol), when applied topically to the skin, may improve the appearance of sagging skin, boost the effects of other antioxidants, increase smoothness, reduce fine lines and give facial muscles a leaner look. In a randomized clinical study, 3% DMAE facial gel applied daily for 16 weeks has been shown to be safe and efficacious in the mitigation of forehead lines and periorbital fine wrinkles, and in improving lip shape and fullness and the overall appearance of aging skin.

Br J Dermatol. 2007 Mar;156(3):433-9.
The antiwrinkle effect of topical concentrated 2-dimethylaminoethanol involves a vacuolar cytopathology.

In order to access the PubMed abstract of this article, visit this website link.
 

Am J Clin Dermatol. 2005;6(1):39-47.
The role of dimethylaminoethanol in cosmetic dermatology.

In order to access the PubMed abstract of this article, visit this website link.
 

Antioxidants such as vitamins E and C, coenzyme Q10, alpha-lipoic acid, glutathione, and others can reduce signs of aging.
 
Acta Dermatovenerol Alp Panonica Adriat. 2008 Jun;17(2):47-54.
Skin aging.

In order to access the PubMed abstract of this article, visit this website link.

 
Alpha-lipoic acid (ALA) 0.5% and proanthocyanidin (PA) 0.3% administered transdermally in a cosmetic formulation supplemented with 2% benzyl alcohol as a penetration enhancer,  significantly enhanced collagen synthesis and deposition.      
        
Connect Tissue Res. 2005;46(4-5):251-7.
Transdermal delivery of amino acids and antioxidants enhance collagen synthesis: in vivo and in vitro studies.

In order to access the PubMed abstract of this article, visit this website link.

Topical Application of Phytonadione, Retinol and Vitamins C and E to Reduce Infraorbital Dark Circles and Wrinkles of the Lower Eyelids
 
 Infraorbital dark circles and wrinkles of the lower eyelids are cosmetic problems that worsen with age. Fifty-seven healthy adult volunteers with dark under-eye circles and wrinkles were enrolled in an open label study to determine whether a gel containing 2% phytonadione, 0.1% retinol and 0.1% vitamins C and E is effective in reducing dark under-eye circles and wrinkles of the lower eyelids. The gel formulation was applied twice daily to the lower eyelid site for 8 weeks. Hemostasis, pigmentation and wrinkles were evaluated by a physician and by the patients after 4 and 8 weeks of treatment. Topical application of the gel decreased not only hemostasis but also wrinkles after 8 weeks of treatment. Of 57 patients, 27 (47%) had reductions in hemostasis. However, pigmentation was not clearly removed by this gel.
 
J Cosmet Dermatol. 2004 Apr;3(2):73-5
The effects of topical application of phytonadione, retinol and vitamins C and E on infraorbital dark circles and wrinkles of the lower eyelids.

In order to access the PubMed abstract of this article, visit this website link.
 
Protection and Reversal of Photodamage with Topical Antioxidants
 
Topical vitamins C and E, as well as topical selenium, protect skin against sunburn, suntan and skin cancer and also reverse the mottled pigmentation and wrinkles of photoaging. However, only certain forms of these antioxidants are stable and active after percutaneous absorption. Benefits of topical application are that the skin attains far higher levels of each antioxidant than can be achieved by taking these vitamins orally and topical application arms the skin with a reservoir of antioxidants that cannot be washed or rubbed off, protecting the skin for several days after application.
 
J Cosmet Dermatol. 2004 Jul;3(3):149-55 
Photodamage of the skin: protection and reversal with topical antioxidants.

In order to access the PubMed abstract of this article, visit this website link.
 

Topical application of niacinamide (such as in a 2% cream) has a stabilizing effect on epidermal barrier function, seen as a reduction in transepidermal water loss and an improvement in the moisture content of the horny layer, and it may be used as a treatment adjunct in atopic dermatitis. In aging skin, topical application of niacinamide improves the surface structure and pigmentary disorders, smoothes out wrinkles and inhibits photocarcinogenesis.

 Cutis 2006 Jan;77(1 Suppl):11-6.
Pharmacologic doses of nicotinamide in the treatment of inflammatory skin conditions: a review. 

In order to access the PubMed abstract of this article, visit this website link.

 

 Int J Dermatol 2005 Mar;44(3):197-202.
Moisturizing effects of topical nicotinamide on atopic dry skin. 

In order to access the PubMed abstract of this article, visit this website link.

 

 J Cosmet Dermatol 2004 Apr;3(2):88-93
Nicotinic acid/niacinamide and the skin. 

In order to access the PubMed abstract of this article, visit this website link.

 Niacinamide can be combined with other active ingredients such as DMAE, sodium hyaluronate, benzoyl peroxide, or metronidazole in a customized medication that can be used as anti-wrinkle or anti-aging therapy or to treat acne or rosacea

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.

In order to access the PubMed abstract of this article, visit this website link.
 

Estrogen Therapy to Prevent or Reverse Skin Aging  

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.            

Exp Dermatol. 2004;13 Suppl 4:36-40
Skin aging and sex hormones in women -- clinical perspectives for intervention by hormone replacement therapy.

In order to access the PubMed abstract of this article, visit this website link.

Exp Dermatol. 2006 Feb;15(2):83-94
Biology of estrogens in skin: implications for skin aging.

In order to access the PubMed abstract of this article, visit this website link.

Eur J Obstet Gynecol Reprod Biol. 2006 Jun 22

J Am Acad Dermatol. 2005 Oct;53(4):555-68; quiz 569-72

Estrogen and skin: the effects of estrogen, menopause, and hormone replacement therapy on the skin.

In order to access the PubMed abstract of this article, visit this website link.

Fertil Steril. 2005 Aug;84(2):285-8
Long-term effects of hormone therapy on skin rigidity and wrinkles.

In order to access the PubMed abstract of this article, visit this website link.


Am J Clin Dermatol. 2003;4(6):371-8
Skin aging and menopause : implications for treatment.

In order to access the PubMed abstract of this article, visit this website link.

Am J Clin Dermatol. 2001;2(3):143-50

Estrogen and skin. An overview.

In order to access the PubMed abstract of this article, visit this website link.

J Dermatol Sci. 2005 Apr;38(1):1-7
Regulatory roles of sex hormones in cutaneous biology and immunology.

In order to access the PubMed abstract of this article, visit this website link.

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.

In order to access the PubMed abstract of this article, visit this website link.
 

A low-dose, topical gel form of diclofenac sodium has been developed in Europe for pain relief and reduction of redness after sunburn.

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.

In order to access the PubMed abstract of this article, visit this website link.
 

 PRURITUS:

Pramoxine Reduces Uremic Pruritus
 
Wake Forest University School of Medicine conducted a randomized, double-blind, controlled comparative trial in a community hemodialysis center to evaluate the efficacy of 1% pramoxine hydrochloride lotion versus control lotion in the treatment of uremic pruritus in adult hemodialysis patients. Pramoxine 1% lotion was applied twice daily to all affected areas of pruritus for 4 weeks, resulting in a 61% decrease in itch intensity. “This safe, convenient and effective topical lotion may potentially benefit the large number of patients affected by pruritus associated with end-stage renal disease.”
 
J Dermatolog Treat. 2008 Sep 24:1-5.
A pramoxine-based anti-itch lotion is more effective than a control lotion for the treatment of uremic pruritus in adult hemodialysis patients.

In order to access the PubMed abstract of this article, visit this website link.
 

Hydroxyethyl Starch-Induced Pruritus Relieved by Menthol/Camphor Lotion
 
Hydroxyethyl starch (HES) is a key component of many colloid volume expanders used in hypovolemic shock and otologic disease. Pruritus is a common side effect. Although classically refractory to treatment with corticosteroids and antihistamines, some benefit has been achieved with topical capsaicin, ultraviolet light therapy, and oral naltrexone.
    A man with severe symptoms and refractory course was treated with a topical lotion containing 0.5% camphor and 0.5% menthol, which was dramatically successful.
   A randomized, double-blind, placebo-controlled trial showed a combination of menthol and phenol to be beneficial in mustard-gas induced pruritis.
 
J Am Acad Dermatol. 2008 Jul;59(1):151-3.
Hydroxyethyl starch-induced pruritus relieved by a combination of menthol and camphor.

In order to access the PubMed abstract of this article, visit this website link.
 

Singapore Med J 2007;48:392-5.
Phenol and menthol in the treatment of chronic skin lesions following mustard gas exposure.

In order to access the PubMed abstract of this article, visit this website link.
 

Naltrexone for Post-Burn Pruritus and Severe Generalized Pruritus in Biliary Atresia 
 
“Severe pruritus is one of the many complications that burn survivors endure as a consequence of healing or healed burn or donor site wounds, [and] continues to be a clinical challenge that is inadequately addressed by traditional therapies. The success of naltrexone, an opioid antagonist, in treating pruritus in other patient populations, supported the concept that it may also be effective in burn survivors.” Opioid antagonists have been shown to suppress pruritus in patients with chronic cholestasis, uremia, atopic dermatitis, and chloroquine-induced itching.
  
“Naltrexone is a well-tolerated medication with little adverse effects [and] may be an effective adjuvant treatment in the management of cholestatic pruritus in the pediatric population.”

Two studies used a topical formulation of 1% naltrexone (or placebo) for 2 weeks to treat patients with localized and generalized atopic dermatitis with severe itching. More than 70% of the patients using the 1% naltrexone cream experienced a significant reduction of pruritus. The cream containing naltrexone had an overall 29.4% better effect than placebo.
 
Burns. 2008 Sep;34(6):797-802.
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Click here to access the PubMed abstract of this article.

Pediatr Dermatol. 2008 May-Jun;25(3):403-4.
The use of naltrexone in the management of severe generalized pruritus in biliary atresia: report of a case.

In order to access the PubMed abstract of this article, visit this website link.
 

J Am Acad Dermatol. 2007 Jun;56(6):979-88 
Treatment of pruritus with topically applied opiate receptor antagonist.

In order to access the PubMed abstract of this article, visit this website link.
 

The following studies evaluated a topical formulation of 1% naltrexone to treat patients with localized and generalized atopic dermatitis with severe itching, and more than 70% of patients using the 1% naltrexone cream experienced a significant reduction of pruritus.

J Am Acad Dermatol. 2007 Jun;56(6):979-88 
Treatment of pruritus with topically applied opiate receptor antagonist.

In order to access the PubMed abstract of this article, visit this website link.
 

 

J Cutan Med Surg. 2005 Oct;9(5):215-6           
Successful treatment of refractory aquagenic pruritus with naltrexone.

In order to access the PubMed abstract of this article, visit this website link.

Itching Relieved with Topical Naltrexone

Pruritus is a very common and distressing skin problem. More than 70% of patients with localized and generalized atopic dermatitis with severe itching who used topical naltrexone 1% cream experienced a significant reduction of pruritus.

J Am Acad Dermatol. 2007 Jun;56(6):979-88 
Treatment of pruritus with topically applied opiate receptor antagonist.

In order to access the PubMed abstract of this article, visit this website link.
 

Aquagenic pruritus is an intense prickling sensation that develops in affected individuals immediately after contact with water at any temperature. Endogenous opiates, like naltrexone, can modify pruritus by influencing the peripheral and central sensation of itch, and have been found to be successful in suppressing the perception of pruritus from many diverse origins including aquagenic pruritus.

J Cutan Med Surg. 2005 Oct;9(5):215-6
Successful treatment of refractory aquagenic pruritus with naltrexone

In order to access the PubMed abstract of this article, visit this website link.
 

 PSORIASIS:

Topical vitamin B12 offers a new therapeutic approach for eczema (atopic dermatitis) and psoriasis, and may be suitable for long-term therapy as no long term adverse effects have been reported. 

British Journal of Dermatology 2004; 150: 977-983.
Topical vitamin B12--anew therapeutic approach in atopic dermatitis-evaluation of efficacy andtolerability in a randomized placebo-controlled multicentre clinicaltrial.

In order to access the PubMed abstract of this article, visit this website link.

 

Dermatology 2001;203:141-147
Vitamin B(12) cream containing avocado oil in thetherapy of plaque psoriasis.  

In order to access the PubMed abstract of this article, visit this website link.           

 

Salicylic acid has been used alone as a treatment for psoriasis, but is most commonly used to increase the penetration of other topical preparations, primarily corticosteroids. In this small study, the use of 6% salicylic acid gel in conjunction with tacrolimus ointment showed statistically significant improvement for the treatment of plaque psoriasis compared with the use of salicylic acid alone.

"For patients with localized psoriasis, and for many of those with moderate psoriasis as well, the mainstay of treatment is still topical therapy. The quality of life is greatly affected in such patients, and they often express high levels of dissatisfaction with current treatment options. Safe, convenient, and effective topical regimens, such as combination therapy with topical tacrolimus and salicylic acid, can be of great benefit in this large population."

Arch Dermatol. 2005;141:43-46
Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment.

In order to access the PubMed abstract of this article, visit this website link.
 

 "Methotrexate has been used as an effective systemic chemotherapeutic drug for psoriasis by dermatologists for over 30 years. Nevertheless, pharmacokinetic data indicate that oral methotrexate can cause a decrease in red and white blood cell and platelet counts and can also cause severe liver damage, diarrhea, and stomach irritation, as dose-related drug-induced side effects. Such indications have limited its prescription by physicians. However, [Syed and Nordstrom of the Department of Dermatology, University of California-San Francisco, and researchers from three other locations note that] if its incorporation in a gel as a topical agent, in a proper dosage. imparts better results without the cited side effects, then such a formulation appears to justify a clinical evaluation. Furthermore, published data have indicated that 70% of patients prefer topical therapy for treating psoriasis."

This article concludes: "methotrexate 0.25% in a hydrophilic gel is well tolerated and significantly more effective than placebo as a patient-applied topical medication to treat psoriasis vulgaris."

J Cutan Med Surg 2001; 299-302
Management of psoriasis vulgaris with methotrexate 0.25% in a hydrophilic gel: a placebo-controlled, double-blind study.

In order to access the PubMed abstract of this article, visit this website link.
 This article concludes: "Methotrexate 0.25% in a hydrophilic gel is well tolerated but is not very effective in controlling the lesions of psoriasis on the palms and soles; however, a higher concentration in a different base with better penetration could possibly provide better results."
 
J Dermatol 2004 Oct;31(10):798-801
Topical 0.25% methotrexate gel in a hydrogel base for palmoplantar psoriasis.

In order to access the PubMed abstract of this article, visit this website link.
Tiwari, Kumar, et al. published a case report of topical methotrexate delivered by iontophoresis for the treatment of recalcitrant palmoplantar psoriasis. In a 46 y.o. male with well-defined bilateral palmar plaques of 6 years duration which were resistant to several therapies, the right palm was treated, as it had more severe lesions. Iontophoresis was performed using cotton gauze soaked in 4 to 6 ml of methotrexate disodium solution 10 mg/ml, once a week for four weeks. The researchers reported 75% improvement after four weeks of therapy. Iontophoresis allows high concentrations of drug to be delivered to a limited area, and may offer a method of reducing total drug accumulation and reduced side effects.

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

In order to access the PubMed abstract of this article, visit this website link.
 

 VITILIGO:

Treatment Options for Vitiligo

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.

In order to access the PubMed abstract of this article, visit this website link.
 

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

In order to access the PubMed abstract of this article, visit this website link.
 

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.

In order to access the PubMed abstract of this article, visit this website link.
 

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.

In order to access the PubMed abstract of this article, visit this website link.

Topical Phenylalanine 
 
Melanocytes may still be 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. Phenylalanine hydroxylase activities increase linearly with inherited skin color yielding eightfold more activities in black skin compared to white skin. 

Camacho and Mazuecos performed an uncontrolled retrospective survey of a group of 193 patients (171 participants after screening) with evolving vitiligo who were treated with oral (50 or 100 mg/kg daily) and topical (10% gel) phenylalanine plus sun exposure . When the study closed, 100% repigmentation was achieved in 122 patients on the face, 35 on the trunk, and 33 on the limbs. Patients who were treated during the months of high solar radiation (and therefore also used the topical phenylalanine) achieved greater repigmentation. No side effects were reported.

Arch Dermatol. 1999;135:216-217
Treatment of vitiligo with oral and topical phenylalanine: 6 years of experience.

In order to access the PubMed abstract of this article, visit this website link.
 

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.

In order to access the PubMed abstract of this article, visit this website link.
 

Mol Genet Metab 2005 Dec;86(4):27-33
Decreased phenylalanine uptake and turnover in patients with vitiligo.

In order to access the PubMed abstract of this article, visit this website link.
  


 

Dermatology Categories:

 

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Acne

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Athlete's Foot

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Chemical Peels  

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Diaper Rash/Incontinence

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Head Lice and Scabies

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Molluscum Contagiosum

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Nail Infection/Removal

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Pigmentation Abnormalities

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Plantar Warts/Warts

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Rosacea

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Scarring and Keloids

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Topical Anesthetics

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Topical Therapy

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Sun Protection

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Photoaged Skin/Wrinkles

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Pruritus

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Psoriasis

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Vitiligo

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