Pharmacy U Vancouver presenter Nat Jones: Getting even – demystifying compounded treatments for hyperpigmentation
Most patients with hyperpigmentation feel victimized and are not happy with the uneven appearance of their skin colour. Finding an effective treatment regimen is their way of getting even. This urge is especially intense when it involves their face. This is where pharmacists can help!
Becoming involved in the field of dermatology for many of us can be intimidating. One of the areas in which a lot of dermatology patients will need help is formulas to treat hyperpigmentation. This is a rewarding potential market segment and having a handful of proven compound options can provide for a need, help develop relationships with practitioners and bring business to your pharmacy. It is a condition seen around the world and effective treatments are highly sought after. In 2021 the world market for skin lightening was over $6 billion US and is estimated to be almost $9 billion by 2028.
The good news is nobody dies from hyperpigmentation, which is largely a cosmetic issue, but many cases can be difficult to treat, creating a need for something different. There are several office procedures offered (lasers and peels) but there are limited mass-produced pharmaceutical options available for practitioners to prescribe for use at home. Knowing the mechanisms and limitations of the active ingredients used in formulating can help provide a positive outcome and minimize adverse events. Knowledge of the pathophysiology of the disease can help with active pharmaceutical ingredient (API) selection as well as professional communication with your medical colleagues.
Which excipients and how much of them need to be added to hydroquinone (HQ) formulas is another area that you will need to understand to provide quality compounds for your patients. Since hydroquinone hates oxygen, it requires antioxidants to be stable and the amount needed varies with the percentage of use in the formula. What if the combination contains tretinoin, how do you protect from major loss of its potency while making the formula? How do you adjust potency of APIs when assessing a patient’s results and/or adverse events.
There are three types of melasma and only one type gets consistently good outcomes from topical therapies. People have different anatomy and that includes positioning of melanocytes. While most patients have melanocytes pointing up from their stratum basale towards their epidermal layer of the skin, some have mixed positioning and others have downward angled focus, forcing melanin into the dermal layer. Since the upward migration of keratinocytes in the epidermal layer is how hyperpigmented cells are shed, thus lightening the skin colour as melanin production is inhibited, if pigment is delivered to the dermal layer this migration has no effect on outcome. This anatomical difference can explain why some patients get mixed or no results when they try topical skin lightening therapies.
Because of potential adverse events from HQ, best practices in dermatology recommend rotation away to other skin lightening APIs. Some patients can’t metabolize it and it causes another more difficult to treat form of dyschromia. Knowing effective alternatives can be a major contribution to your patient’s safe long-term therapy.
Come and learn how you can assist your practitioners by providing a variety of treatment options and formulate with confidence!
Nat Jones will be presenting at Pharmacy U Vancouver on Nov. 4, 2023.