COMPOUNDING: FAVORITE FORMULAE ----------------------------------------------------------------- ....I'm curious what you compound the most often in your practices, or contrarily if you do not compound what your rationale is (I don't do it much but lots of folks do). I'm doing a project on compounding and this seems like a quick way to get feedback. Mark Ling, M.D., Ph.D. ---------------------- In my practice I have the pharmacy compound a class II steroid with a creme for treatment of large areas. Usually 1:3 dilution. William Liss MD --------------- 0.25 to 0.5% phenol and/or menthol, and or 5 to 20 % CCT in petrolatum or aquaphor or eucerin. 5 to 20% Sal Acid in olive oil or petrolatum 5 to 10% urea in aquaphor with or without 10% sal acid or CCT. Guy Webster ----------- 1) tar and sal acid in a topical steroid for psoriasis 2) Hydrocortisone powder in Nizoral cream for seborrheic dermatitis 3) Nystatin in zinc oxide paste for diaper dermatitis/candidiasis I'm sure I would compound more frequently were it not for haste and laziness on my part. Mark Valentine MD ----------------- My favorite compound is iodohydroxyquinoline (Vioform) powder 1 or 2% in the old 1-2-3 paste, which is: Burow's Solution 10.0 ml Aquaphor 20.0 gm Paste of Zinc Oxide qs ad 60.0 gm This is fabulous for diaper rash, leg ulcers, tinea cruris, candidiasis, and a whole host of subacute and acute dermatoses. (Stains yellow) Jerry Litt MD ------------- Pros of compounding include: 1) allows you to put just what you want in the jar. You can include your favorite items that just can't be found in one place in any other prepation. 2) Its fun - you get to write all those "aa" and "qs" things we never get to do much anymore on Rx s. 3) impresses the patient. Cons 1) You have little idea if the base and active ingredient(s) actually work together. So you may be using an expensive placebo. 2) Costs a lot. Have the pharmacist charge for mix of menthol, triamcinolone and Aquaphor (my most common mix) and you have a much more expensive product than the three alone. 3) Fewer pharmacists compound anymore. In WA it takes a special license and only one or two pharmacies in our town have the license. Having said that, my main compounds are: Triamcinolone, Aquaphor and menthol 3% thymol in 70% EtOH for paronychia. Jerry Eisner MD --------------- My favorite is equal parts of an imidazole cream (currently Spectazole, previously Miconazole or Nizoral) and 2.5% hydrocortisone cream. It's terrific for seb derm, candidal intertrigo, and inflammatory tinea; also when you're not sure which you're dealing with! Another useful one is 1/4% menthol and 1% hydrocortisone in lubriderm lotion; good for large itchy areas of pityriasis rosea,etc. Then there's the old standby of 5%LCD and 3%salicylic acid in petrolatum for psoriasis. Yelva Lynfield, MD ------------------ Having grown up with a father who was trained as a dermatologist at NY Skin and Cancer in the days prior to cortisone and antibiotics, I was exposed to two treatment modalities that most of us are no longer exposed to, namely x-ray therapy and compounding. 1) Although I would agree with most of my fellow derms that I would bx and then C&D the MD's wart, I would give serious consideration to suggesting X-ray. My father used to treat difficult warts with x-ray all of the time. I took over his practice and have never seen one of his patients develop a SCC from that treatment. 2) The problem I have with compounding is expense and finding a pharmacist who knows how to do it well. My favorites that have not already been mentioned include: a) equal parts of Elixer of Benadryl, Dexamethasone suspension, mycostatin suspension and TCN suspension for apthae, oral ulcers, oral herpes, etc. b) a paste containing napthal, resorcinal, and sulpher in soft soap ( I am not in my office right now and don't remember the percentages and all of the ingredients exactly). I use this as an in office treatment for my oily, acne patients applying it for 1-15 minutes. When exfoliation went out of favor in the 70's-80's, I continued to use this treatment that I learned from my father with great success. Now that AHA's have brought exfoliation back in favor for acne, I still use this paste as I find it much better. c) menthol, camphor and phenol in a shake lotion for pruritus when all else fails. d) I used to like estar gel, keralyt gel, and lidex gel for scalp psoriasis, but can't get keralyt anymore. Does anyone know of a substitute for Keralyt and where to get it? e) 1-3% thymol in chloroform or ETOH for chronic/subacute paronychia That's enough for now. Jeff Marmelzat, M.D. -------------------- 1. Equal parts 2.5% HC cream and Nizoral cream for Seb. Derm. 2. 5% Hydroquinone powder in RetinA or Renova cream(with some HC if patient not rosacea-prone) for photoaging-dyschromia or melasma. 3. 20 % LCD in Topicort for resistant nummular eczema. 4. 25% 0.025 or 0.1% TMC cream +1/4% menthol +1/4% camphor in Cetaphil for itching or minimal atopic derm. 5. Equal parts Topicort, Estar, and Keragel(from Elle, substitute for Keralyt) for scalp psoriasis. Chuck Fishman MD ---------------- Bleaching Solution Camphorae 1.0 Salicylic Acid 2.0 Hydrarg Bichlor 0.06 Alcohol QSAD 50.0cc BID-TID to melasma x 2-3-months then 1-2 x weekly maintenance along with Retin-A HS for widespread Nummular eczema TAC Cream .1% 8oz Lubriderm lotion (unscented) 8oz Maida L Burrow MD ----------------- Crude coal tar LPC Cade oil Resorcinol Sulphur Sal ac Various emollients etc. are you looking for formulae? Rational: any doctor can prescribe a tube of steroid cream. It takes a dermatologist to get a really good mix going. Chris Clay MD ------------- My favorite "compound" is rediculously simple but marvelously effective: Lidex cream 60g Bath oil (cheap, generic) 60cc Tap water 60cc Pharmacist can mix up (if he/she doesn't charge too much) or pt can. Shake well and apply tid. GREAT for asteatotic eczema, atopic dermatitis. Thin, so easy to apply to large areas. Have yet to see atrophy. Hydrates and soothes, also antiinflammatory and antipruritic. Easy to use, so compliance is super. Dan Mitchell, MD --------------- Subject: Re: Comp- add Flagyl to facial 'roids to prevent rosacea I have the pharmacist grind up metronidazole (from tabs or caps) and add it to the topical steroid, 1 gram per 100 grams of steroid cream (w/w = weight in weight around here). Don't know if you can get Flagystatin in the US, but I sould add its great for the many older folks who have rosacea and seb derm, because it helps both conditions, and its only about $15 US per 50 gram tube. I suppose you have a similar vaginal cream in the US (I'm at home and my PDR is at the office, so I don't know for sure) - be careful to explain to men (in particular) why you are ordering this stuff with 99 refills to put on the FACE bid ("because its cheap, its nice, and it works!") KC Smith MD FRCPC ------------------ The hot tip on Dovonex from the company is DON'T USE SAL ACID - the low pH will rapidly degrade the calcipotriol. Urea 10% works fine - I use it all the time for thick psoriaisis and psoriatic nail dystrophy (pu it on and around BUT NOT UNDER the nails). KC Smith MD FRCPC ----------------- Loprox for diaper derm 50:50 Loprox and zinc oxide, sometimes with ! or 2% HC, works great for diaper rash - Loprox has a good antifungal AND antibacterial spectrum, and as a bonus also has some anti-inflammatory effect, reducing the need for HC. Apply generously at every diaper change. 100 g, 10 refills. KC Smith MD FRCPC ----------------- Whenever compounding is done there is always the question of stability of the components. For example, I am aware of several compounds which are stable for many months, but with a change of vehicle become unstable. Additionally, chemical reactions between actives and exipients, plus the ability to support the growth of bacteria is a strong function of the vehicle. These dangers increase when the compounded "drug product" is stored for long periods of time. Rick Sharpe ----------- I often compound Sarna lotion with Lidex or other equivalent steroid in a 1:4 dilution for treatment of large areas of nummular dermatitis or winter itch. Isaac Novick, M.D. ------------------ I would compound a lot more were it not for the formidable expense to the patient and the very real doubt as to whether the pharmacist will accurately mix according to my instructions. It is a lot cheaper for the patient to give him separate prescriptions for 2 1/2 hydrocortisone cream and Spectazole cream and instruct him to apply them one on top of the other to treat tinea cruris than to have the pharmacist mix the two together. Isaac Novick, M.D. ------------------ 5/20/96