Psoriasis and Compounding Pharmacies

Psoriasis is a common dermatologic problem faced by a number of Australians. Symptoms can typically include dry skin, which may be thickened or red with a scaly appearance, swelling, itching, and soreness. Becuase of the topical nature of psoriasis, it can negatively affect quality of life with its often unpleasant symptoms. Many prescription treatments are available to alleviate symptoms, and a compounding pharmacy can offer a host of additional treatment options for the management of psoriasis.¹

Although early onset is possible, psoriasis occurs primarily in adults and begins in the immune system. The exact trigger for this proliferation of cells is unclear; however, evidence shows that the cause is likely to be from a number of factors which may include, genetic predisposition and environmental factors. Environmental stimuli such as injury, infection, medications, stress, and dry, harsh climate conditions likely contribute to the development of psoriasis.

Common Treatments

Psoriasis can be difficult to treat, and traditional methods do not work for all patients. Topical treatment is typically the first line of defense and may work well for many patients with mild-to-moderate cases. Some topical treatments are commercially available in certain strengths and forms, either by prescription or over the counter, including the following:

• Anthralin
• Calcipotriene ointment (Daivonex)
• Topical steroids
• Salicylic acid
• Coal tar
• Sulphur
• Tacrolimus

Other treatment options include the use of systemic therapy, which generally is reserved for patients with moderate to severe cases and may cause adverse effects.

Compounded Treatments

Whereas commercial topical treatments can be effective for many patients, other patients with more severe cases may require a specialized prescription available from a compounding pharmacist. In such cases, a wide variety of options are available to the doctor and the patient without having to resort to systemic therapy.

One product that has proven successful in some patients is a preparation of zinc pyrithione 0.02{648ff2b140dd79f8b10f01740237e66061b7c0f8b396ba52d99047c684c8722c} in a topical spray or solution. Clobetasol 0.05{648ff2b140dd79f8b10f01740237e66061b7c0f8b396ba52d99047c684c8722c} may be added to this compound and can further enhance its effectiveness.³ This preparation, formerly commercially available is no longer. Doctors may find other discontinued products effective with their patients, however, have been able to refer the patients to compounding pharmacies, where the product can be compounded.

Certain systemic treatments may be converted to topical forms to meet the needs of a patient without exposing the whole body to the medication. Cyclosporine, a treatment option that generally is used systemically, has shown a degree of effectiveness in topical forms for the treatment of psoriasis, and it also may be prepared according to a doctor’s specifications.⁴ Tacrolimus, another systemic treatment for psoriasis, has shown effectiveness in topical compounded form when used after the lesions have been descaled and the skin has been occluded.^5,6

Compounded treatments also may include combinations of topical steroids, coal tar, or salicylic acid in varying strengths and vehicles that may not be commercially available. These medications may be prepared in bulk and may be more cost-effective for some patients.

The key message for patients that have suffered from Psoriasis for a number of years and may have tried a number of common prescription medications, is to contact a compounding pharmacy and our pharmacists will be happy to share their experiences about a variety of Psoriasis treatments. Contact us on 1300731755 or email here.

References are available upon request. Sources include Australasian College of Dermatologists (A-Z of skin: Psoriasis.), Mayo Clinic (Psoriasis Symptoms),NHS Choices (Psoriasis), Baker, C. et al. (Treatment goals for moderate to severe psoriasis: An Australian consensus. Australasian Journal of Dermatology (2013))