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By Melissa Merrell Rhoads, PharmD, PCCA Director of Formulation Development, and Andrea Branvold-Herr, MS, RPh, PCCA Clinical Resources Manager
The winter season is often accompanied by health challenges. The cold air can contribute to various skin conditions, and it can dampen the immune system, leading to illness as well. Fortunately, where patients need help, compounders are there with unique options. Over the years, we have published some great information on compounding for this season in our members-only magazine, the Apothagram, so we thought it would be helpful to bring some of it together into one place and share it here. Below you will find excerpts from some of these past Apothagram articles. Enjoy!
Compounding for Patients with Dry, Cracked and Itchy Skin From “Compounding for Winter Conditions,” by Ranel Larsen, PharmD, PCCA Clinical Compounding Pharmacist, in the December 2015 Apothagram.
A big complaint of the winter months is dry skin, or xerosis. Temperature and humidity are some of the factors that can influence the water content of the skin. Without adequate hydration, the skin can dry out and crack. This can cause itching, inflammation, scaling and rough texture, and can lead to infection.1 It is common to experience dryness in the winter months when we all spend more time indoors in low-humidity environments. One of the most effective ways to treat dry skin is to increase the moisture content. This can be accomplished by using PracaSil®-Plus. It contains silicones and pracaxi oil, which is rich in fatty acids and lipids. An excellent ingredient to consider with this base is urea, which can be used to increase the water-holding capacity of the skin. It promotes hydration by increasing stratum corneum water uptake and enhances the water-binding capacity. It also has a mild keratolytic action, removing excess keratin in dry skin conditions.2 PCCA Formula #10417 uses urea in PracaSil-Plus as a topical gel.
Another option is compounding a lotion bar. You can use many different molds for this. PCCA Formula #10925 is our basic lotion bar formula, containing 33% coconut oil. Coconut oil has emollient properties and significantly improves the hydration of skin.3 This oil also contains 62% medium-chain fatty acids, which in addition to its antioxidant properties are believed to be responsible for its anti-inflammatory activity.4
XemaTop™ is another option as well. It’s a compounding base that was specifically designed for the topical delivery of active ingredients in formulations for patients with dry skin conditions. It replenishes the lipids within the skin and helps restore the skin’s barrier, nourishing the skin and preventing water loss.
From “6 Easy Compounding Formulas for Itchy Winter Skin,” by Jerra Banwarth, RPh, FAPC, PCCA Education and Training Manager, in the December 2014 Apothagram.
What recommendations can we as compounders make for dry skin? Patients who complain of dry, cracked skin, or itchy and scaly skin may benefit from some of the suggestions below.
These formulations use different ratios of PracaSil-Plus and Spira-Wash® Gel. Because it’s silicone-based, PracaSil-Plus can help soften and soothe irritated skin. Spira-Wash Gel is a water-washable base that can solubilize added ingredients in formulations, and it’s also a humectant.
Commonly Requested Hydrating Formula PCCA Formula #10416, urea in PracaSil-Plus and Spira-Wash Gel, is great for moisturizing the feet, elbows and hands. Apply a light application to these areas several times per day to encourage hydration. If knuckles or hands crack, an application after hand-washing may be beneficial.
Commonly Requested Formula for Patients with Psoriasis PCCA Formula #11026, which is zinc pyrithione, clobetasol propionate and cyanocobalamin in PracaSil-Plus and Spira-Wash Gel, may be beneficial. Clobetasol propionate is a potent corticosteroid used to help reduce itching and the inflammatory response, and zinc pyrithione has antibacterial and fungistatic properties.
Commonly Requested Formulas for Patients with Eczema PCCA Formula #11187, cyanocobalamin and urea in PracaSil-Plus, is suitable for children. Vitamin B12 (cyanocobalamin) topically has been studied in children and is applied twice daily.5 Cyanocobalamin has been shown to reduce inflammatory cytokines associated with eczema.6 Orally, cyanocobalamin has poor bioavailability; therefore, topical application has been the preferred route, studied in both children and adults.
Since many people ski at this time of year, consider a cosmetic formula containing sunscreens as well, such as PCCA Formula #10752, oxybenzone and octinoxate in PracaSil-Plus.
PCCA members with Clinical Services access can find the formulas for dry, cracked and itchy skin listed above in our formula database.
Compounding for Flu Season From “Compounding Opportunity!” by Melissa Merrell Rhoads, PharmD, PCCA Director of Formulation Development, in the February 2014 Apothagram.
Flu season is upon us, and with that often comes the shortage of Tamiflu® Oral Suspension due to a strong demand. PCCA has several formulas to support our members as they serve their patients and practitioners.
PCCA Formula #9360, an oseltamivir oral suspension, provides compounders with a formulation that has gone through stability testing. Please refer to the March/April 2007 issue of The International Journal of Pharmaceutical Compounding (Vol. 11, No. 2) for a copy of the published study, “Stability of Oseltamivir in Various Extemporaneous Liquid Preparations,” which was co-authored by PCCA’s Lawson Kloesel, RPh. This formula is unflavored because it was a direct copy from the study in order to obtain the extended beyond-use date of 90 days.
We have also added other formulas to our database that were written to be more palatable with the addition of sweeteners and choice of flavor. However, since they differ from the one used in the stability study, the beyond-use date is only 14 days per USP guidelines.
PCCA Members with Clinical Services access can view the oseltamivir formulas mentioned above in our formula database.
Recommended Flavors to Add
Recommended Combinations of Flavors to Add
For more compounding opportunities during the flu season, PCCA members can look at our compounding ideas for winter and flu season document on the Members-Only Website. For nutritional supplement options, they can see Wellness Works’ newsletter on immune support. If PCCA members with Clinical Services access have questions about compounding options for winter conditions, please contact our clinical compounding pharmacists at 800.331.2498.
Melissa Merrell Rhoads, PharmD, PCCA Director of Formulation Development, received her pharmacy degree from Mercer University in Atlanta, Georgia, in 1995. She currently is involved with and oversees the development and implementation of new formulas at PCCA. She had more than six years of compounding experience with pharmacies in Georgia and Florida prior to joining the PCCA staff in 2004. Her areas of interest include women’s health, veterinary and pain management compounding.
Andrea Branvold-Herr, MS, RPh, PCCA Clinical Resource Manager, is interested in all areas of pharmacy, but in particular women’s health, marketing and sales. Before joining PCCA’s Business Intelligence team in her current role of managing the Concierge Compounding program, Andrea was a PCCA pharmacy consultant for 20 years. She holds a MS in pharmacy administration from The University of Texas, a BS in pharmacy from the University of Houston and a BBA in finance from The University of Texas.
A version of this article previously appeared in PCCA’s members-only magazine, the Apothagram.
References
These statements are provided for educational purposes only. They have not been evaluated by the Food and Drug Administration, and are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment.