If you struggle with more than one skin condition, you may be in need of drug compounding, a product-mixing practice dermatologists often use for patients whose needs cannot be met by traditional over-the-counter products.
Potent Product Delivery
In Miami dermatologist Dr. Deborah Longwill’s office, she often relies on product compounding to treat skin conditions like acne, dermatitis, rosacea and melasma. “A few of our most popular prescription products to compound are clindamycin, tretinoin, anti-fungal creams, spironolactone, hydroquinone, and clobetasol. Oftentimes, we prescribe these alongside over-thecounter products like niacinamide, hyaluronic acid and salicylic and lactic acid. Together, the products create a more potent solution for hard-to-treat conditions.”
Customization is King
West Palm Beach, FL dermatologist Kenneth Beer, MD says compounding “enables me to match the unique problems of the patients’ skin with a product designed for their particular issue.” Because he’s based in Florida, most of Dr. Beer’s patients suffer from hyperpigmentation, and he says compounding is a great way to diminish signs of sun damage. “I like to compound skin lighteners and treatments for fine lines and wrinkles,” he says. “Most commonly, that involves the use of tretinoin, steroids and acids like kojic acid.”
The Injection Add-On
While mixing skin-care topicals and prescriptions is the most popular method of compounding, Omaha, NE dermatologist Joel Schlessinger, MD uses compounding with injections and filler. “We mainly compound lidocaine injections with sodium bicarbonate,” he says, adding that this combination makes the injections less painful and results in a happier patient. “We also add a small amount of lidocaine compounded with epinephrine to each of our volumizing fillers. This addition results in less bleeding and bruising among my patients who are undergoing injections.”
“Not only is compounding excellent for customization, but it is also quite economical and ideal for cost containment,” says Bloomfield Hills, MI dermatologist Linda C. Honet, MD. “I know that my own prescribing habits have changed as healthcare coverage for medications has become inconsistent. I like to take advantage of being able to vary the percentages, potencies and combinations of topical medications to suit the needs of my patients.”
These combinations can make injections less painful—and the patient happier.
Dr. Honet adds that treating acne most often requires several stronger topicals, including retinoids, benzoyl peroxide or acid-based exfoliants. “There are some medications, like Epiduo Forte or BenzaClin, that are commercially available and take advantage of a single-step application with two actives at once, but they are not truly compounded medications by definition. These are also often quite expensive at times, so I prefer in-office compounding.”