Pediatric & Adult Dermatology
Breakthrough, compounded medications for a variety of skin conditions
TUBEROUS SCLEROSIS COMPLEX
Tuberous sclerosis complex (TSC) is an orphan genetic disorder that causes non-malignant tumors to form in many different organs, primarily the brain, eyes, heart, kidney, skin and lungs. Most people with TSC have changes in their skin due to uncontrolled cell proliferation resulting from a genetic mutation in the TSC1 or TSC2 tumor suppressor genes. Angiofibromas are skin tumors which initially may appear in early childhood and arise from abnormally increased blood vessel growth in the skin. They are usually distributed over the centrofacial areas, particularly near the nasolabial folds, onto the cheeks in a butterfly pattern, and on the chin.
Vascular anomalies describe a spectrum of rare diseases including malformations and vascular tumors. Vascular anomalies are often characterized by debilitating clinical manifestations such as disfigurement, chronic pain, coagulopathies, and organ dysfunction. Superficial anomalies are commonly associated with frequent bleeding and the leakage of lymphatic fluid, providing an easy entrance for skin and soft tissue infection. Such infections may predispose to long term issues with chronic hospitalizations, wound breakdown, recurrent infections, and significant morbidity and even mortality, as soft tissue infections can rapidly progress to bacteremia and severe sepsis.
Port Wine Stains are progressive congenital malformations of capillary blood vessels within the skin. Initially, capillary vascular malformations typically present as flat red patches and macules. As opposed to hemangiomas of infancy which spontaneously regress, capillary malformations are permanent malformations. If not treated, these vessels progressively enlarge, thicken, substantially grow in proportion to the child’s growth and become darker in color during adulthood, presenting as nodular plaques. Early treatment can result in destruction and resolution of such vessels. In the past, treatment of capillary malformations has been limited to laser therapy. We offer a topical compound that can be combined with laser therapy. Combination therapy has shown more success than either therapy alone.
HAIR LOSS DISORDERS
Hair loss disorders represent a heterogeneous group of conditions with various clinical features, etiologies and pathologic findings. Hair loss can be observed in children, men and women of all ages and is often distressing and has a significant impact on the social well-being of the affected individual. Hair loss may be related to many different factors such as family history, hormonal changes, autoimmune processes, medication therapy and radiation. We are happy to offer customized topical treatment options for several different forms of hair loss, including alopecia areata, androgenetic alopecia in men, female pattern hairloss, frontal fibrosing alopecia and chemotherapy-induced hair loss.
We most recently were mentioned in an article that one of our pharmacists collaborated on for a paper for Janus Kinase Inhibitors for Pediatric Alopecia.
Vitiligo is a skin pigmentation disorder that is characterized by the development of white patches due to loss of melanocytes in the skin’s epidermal layer. The disease is often progressive, resulting in white skin patches of increasing size that are in contrast to neighboring areas of normal, darker skin. Individuals affected by vitiligo often experience stigmatization, decreased self-esteem and a decreased quality of life. Our pharmacy offers several topical compounds for vitiligo, including formulations for depigmentation and repigmentation.
Warts are benign skin growths caused by human papilloma virus (HPV). They are often observed in children and young teenagers but can also occur in adults. Warts are particularly common and bothersome on hands and feet. Sometimes, warts are difficult to treat and do not respond to over-the-counter medications, freezing or other commercially available first- and second-line therapeutic options. Warts can also represent a therapeutic challenge in immunocompromised patients. We offer a number of compounded prescription medications for difficult-to-treat warts and are happy to recommend a customized formulation.
Ichthyoses are a heterogenous group of keratinization disorders of the skin that are mostly inherited. The inherited forms include lamellar ichthyosis, a debilitating orphan disorder that presents with severe generalized hyperkeratosis and dry, scaly, thick skin across large areas of the body, among other possible manifestations such as hair loss, respiratory problems and abnormally formed fingernails and toenails. The signs of lamellar ichthyosis are present at birth. Mutations in various different genes can cause the disease. These genes usually make proteins that are found in the epidermis, the outermost layer of the skin. Scaling of the skin may occur only on the extremities or on larger areas of the body in more severe cases.
Different oral retinoids at customized doses are an important therapeutic option for severe scaling. Sometimes, the systemic treatment of lamellar ichthyosis with retinoids is not suitable due to the risk of adverse events such as increased serum triglycerides and liver enzymes. Mechanical scale removal is clinically not efficacious and associated with recurrence. Particularly in young children, the treatment with topical alternatives including salicylic acid, retinoids and lactic acid/ammonium lactate may be associated with toxicity due to the required long-term application to sometimes very large skin areas. We are able to compound a cost-effective, non-toxic topical preparation that likely regulates keratinocyte proliferation and has been used successfully in infants as young as several months.
CUTANEOUS T-CELL LYMPHOMA
Cutaneous T Cell Lymphoma (CTCL) is a malignancy involving the skin. CTCL is more often observed in men than in women and predominantly affects men in the 50s and 60s. Most patients experience only skin symptoms such as dry skin, severe itching, rash and swollen lymph nodes. However, in patients who progress to later stages of the disease, other organs may become affected. The most common forms of CTCL are Mycosis fungoides and and Sézary syndrome. Skin-directed treatment strategies include the use of topical chemotherapy. We offer different formulations for CTCL that are meticulously compounded at customized stengths.
Pruritus, or itch, is a common symptom that is associated with many skin disorders but may also appear as a feature of diseases that primarily affect organs other than the skin or can be induced by certain drugs. Itch occurs when signals are transmitted along specific nerve fibers; the development of itch is very complex and not only related to the skin but also to parts of the brain and the spinal cord. Pruritus can be acute (lasting less than six weeks) or chronic. The urge to scratch is often very distressing and associated with a high risk of open wounds, scarring, and skin infections. We offer a number of novel, innovative therapeutic options for patients with acute or chronic itch.
Hyperhidrosis is excessive sweating. Sweating is a vital natural mechanism for the body to cool itself when too hot. However, when sweat is produced by the body without the physiological need to regulate its temperature, it is excessive. Excessive sweating usually involves one or two sites of the body such as hands, feet or armpits, while the rest of the body remains dry. It is often embarassing and uncomfortable for the affected individual. It may also become problematic for individuals who work in a field requiring the extensive use of their hands. We offer topical compounds that may alleviate excessive sweating, without systemic side effects.
Calcinosis cutis is a disorder characterized by abnormal deposits of insoluble calcium salts in the cutaneous and subcutaneous tissue. These deposits can be caused by a variety of factors including abnormal metabolism of calcium or phosphate, local tissue injury that allows for calcium to build up under the skin by binding to other elements, and medical therapy for a differen condition. Calcium salt deposits often present as skin-colored, white or yellow firm papules or plaques that may eventually ulcerate or be associated with the extrusion of a chalky material. We offer a topical medication that, as an alternative to surgical removal, may help to dissolve the deposits and prevent ulceration.
Skin infections can be caused by a variety of viruses, fungi, bacteria and protozoa. The types of available treatments range from antivirals, antifungals and antibacterials to antiparasitics. We offer a variety of drugs that we can compound as innovative formulations to customize it for the respective condition and to accommodate the patient’s needs.
Lupus is a chronic inflammatory disease of unknown cause. It is an autoimmune disorder, which means the body’s immune system attacks its own organs and tissues. Symptoms may vary from patient to patient and can involve any organ. A variety of medications are prescribed for Lupus. Anti-malarial drugs are among the available treatment options and often prescribed to patients with less severe disease or when they are first diagnosed. We offer customized compounding for patients with lupus.
Rosacea is a common, chronic condition that causes redness on the center of the face. Symptoms may flare up for weeks or months and then diminish for a period of time. It may also cause thickening of the skin on the nose, making it appear bulbous. Chemistry Rx compounds a topical treatment to reduce the symptoms associated with the condition.
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A prescription from a licensed practitioner is required for compounded medications.
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