Podiatry
Podiatrists and other healthcare professionals encounter numerous problems that may be helped with compounded medications:
- Arthritis
- Athlete’s Foot
- Diabetic Neuropathy
- Dry Skin
- Edema/Swelling
- Inflammation
- Muscle Spasms
- Nail Removal
- Neuralgias/Neuropathic Pain
- Plantar Warts/Warts
- Onychomycosis (fungal nail)
- Tendonitis
- Wound Care
Topical & Transdermal Therapy to decrease side effects
As topical formulations are developed, they provide hope for more effective drug combinations, with fewer systemic adverse drug effects and drug-drug interactions.” For example, research has shown that topically applied ketoprofen provides a high local concentration of drug below the site of application but decreases systemic exposure and significantly reduces the risk of gastrointestinal upset or bleeding. When properly compounded into an appropriate base, tissue concentrations of ketoprofen were found to be 100-fold greater below the application site (knee) compared to systemic concentrations. Sever disease is the most common cause of heel pain in pre-pubertal children. A case report described the use of topical ketoprofen 10% gel as an adjunct to physical therapy to relieve pain and inflammation.
Neuropathic pain includes a variety of conditions such as diabetic neuropathy, phantom limb pain, reflex sympathetic dystrophy (RSD or Complex Regional Pain Syndrome), and pain caused by blunt trauma or crushing injuries. Symptoms of neuropathic pain may not be evident for weeks to months after the injury. Optimal treatment may involve not only the use of traditional analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, but may also include topical or transdermal medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA antagonists. “Combination therapy is frequently the only effective approach for managing the complex array of chemical mediators and other contributors to the individual pain experience.
Anti-fungal therapy
Fungal infections of the feet are commonly associated with dry, cracked skin surrounding the plantar surface and heel fissures. Hyperkeratosis can have various etiologies, and chronic conditions are often quite difficult to treat. Moccasin tinea pedis is typically resistant to topical antifungal therapy when used as sole therapy, because the scale on the plantar surface of the foot impedes or limits the absorption of the antifungal agent. However, one study showed a 100% cure rate was achieved in 12 patients with confirmed moccasin tinea pedis who were treated with topical 40$ urea cream and antifungal cream concomitantly for 2 to 3 weeks.
Athlete’s foot and onychomycosis (fungal nail) are common problems. 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 agent (e.g. terbinafine Hcl) can be prepared in a pharmaceutical grade DMSO and applied topically…topical medication can be very useful in delivering the drug directly to the problem area. Also topical medications usually have a lower adverse drug-reaction profile and are not prone to drug-drug interactions, as are systemic medications, if used properly.” We utilize specialized equipment, such as an ointment mill, that allows us to compound formulations containing much higher concentrations of urea than can be prepared using traditional methods.
Nail Removal
“Chemical (using 40% urea) or surgical removal of the nail, combined with topical agents and oral agents, may be necessary in some nondermatophytic fungal infections.” Urea plasters have been shown to be effective for non-surgical removal of traumatized, dystrophic, or diseased nails, and may even be superior to surgical excision. The use of urea plasters can be much less costly, several nails can be treated in one session, and the procedure is essentially painless. Because there is a significantly decreased risk of infection or hemorrhage, the procedure is ideal for treating diabetics and others with vascular insufficiency and peripheral neuropathy.
Wound Care
Medications which improve capillary blood flow can be added to a compounded medication to enhance circulation at the wound margins and promote healing of the injured area. Traumatic wounds and pressure sores may heal more quickly if treated topically with phenytoin (which is used orally for anti-seizure therapy). Nifedipine has been used transdermally to treat difficult-to-heal wounds on the feet in patients with diabetes and club foot. It is hypothesized that nifedipine creates a localized peripheral vasodilation, resulting in increased blood flow, which accelerates epithelialization and possibly microvascular neogenesis.
Warts
Customized medications can be compounded for the treatment of warts [cimetidine, glutaraldehyde, cantharidin, or squaric acid dibutylester (SADBE)], plantar warts (sodium salicylate), and molluscum contagiosum (potassium hydroxide).
Combinations to improve therapy
Numerous compatible medications can be combined into a single dosage form for ease of administration. Also, for some therapies, a synergistic effect can be achieved permitting decreased doses of each drug.
Penetrant enhancers can be added to improve the extent of absorption of topically applied medications.
Iontophoresis & Phonophoresis
Iontophoresis facilitates delivery of medications into the tissues beneath the skin by electronic transport of ionized drugs in solution. Acetic acid iontophoresis is effective in the treatment of heel pain. Iontophoresis of dexamethasone for plantar fasciitis should be considered when more immediate results are needed. Iontophoresis has been used to successfully treat plantar hyperhidrosis.
Phonophoresis is a technique that combines topical drug therapy with ultrasound to achieve therapeutic drug concentrations in muscle and other tissues beneath the skin. Ultrasound gels can be formulated to contain medications such as anti-inflammatories and/or anesthetics.
