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Compounding for Psoriasis
Custom dermatological compounds that are efficacious and economical.
Psoriasis impacts about 7.5 million people in the US. Individuals with psoriasis experience higher rates of many comorbidities, including cardiovascular disease, heart attack, stroke, metabolic syndrome, and depression among others. 1
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Psoriasis is a non-contagious skin condition that develops when the body makes skin cells too quickly (in days rather than weeks). The thick, scaly patches result from clusters of these extra skin cells at the surface of the skin. It is a chronic, inflammatory, multisystem disease affecting up to 3.2% of the U.S. population.
Plaque psoriasis is the most common type, named for the thick, scaly patches that develop on the skin. About 80 to 90% of people with psoriasis experience these plaques, and they may appear anywhere on the skin but are most often found on the knees, elbows, lower back, or scalp. They vary in size and tend to be itchy. Without treatment, they may sting, burn, or feel painful and tight.
Psoriasis is typically a life-long condition, with the exception of some children who have guttate psoriasis. Therapeutic intervention may encourage clearer or even clear skin. Patients require counseling and education to assist them in identifying triggers, developing a regular skincare routine, and understanding how to live a healthy lifestyle.
Psoriasis is linked to associated disease risk, including psoriatic arthritis and diabetes. Dermatologists are often best placed to identify early signs of secondary diseases. 2
Genetic predisposition and immune system dysfunction both play a role in causing psoriasis. Psoriasis is heritable with a clear genetic component. However, not all psoriasis occurs in patients with genes that indicate an increased risk. Similarly, some patients possess the genes that increase the risk of psoriasis but never develop it, suggesting an environmental trigger induces psoriasis. Part of the pathology of psoriasis is an autoimmune attack by T-cells, which stimulates the body to make new skin cells more often. Different people experience different triggers, and avoiding triggers can reduce flare-ups.3
Common psoriasis triggers include:
Psoriasis typically responds well to treatment. By managing a patient’s condition, it is possible to mitigate its effects and avoid serious flare-ups.
Treating psoriasis is an ongoing process, and it is important to educate patients to ensure they:
Can identify triggers
Adhere to their treatment plan
Understand remissions
Patients may undergo remission, which can last for months or years (typically 1 to 12 months). Given the unpredictable nature of psoriasis, it is vital to manage patient expectations by stressing that remissions are most likely temporary and that it may be necessary to alter the treatment plan to keep psoriasis stable and clear or nearly clear and/or control a flare-up.
Patients must also be counseled if their treatment plan should be discontinued slowly to prevent psoriasis from worsening (rebounding). Psoriasis rebounds can be serious. 4
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There are many over-the-counter (OTC) treatments for patients with mild psoriasis. It’s best to introduce new products with care and to test them on a small area to mitigate possible reactions or irritation.
Coal tar: Coal tar can lessen the itching and flaking; reduce redness, swelling, and scaling; and slow the rapid growth of skin cells. Coal tar is available as a shampoo, cream, ointment, and bath solution. It is also compounded into topical preparations and combined with prescription strength ingredients.
Hydrocortisone creams and ointments: A mild hydrocortisone often works well for small patches of psoriasis to reduce itching and decrease inflammation. With moderate to serious outbreaks, consider prescription corticosteroid. For cracked or bleeding skin, ointments tend to be more soothing than creams. Steroids may be compounded with additional active ingredients as a multi-phasic therapy.
Moisturizers: Non-irritant moisturizers can benefit anyone suffering from psoriasis. They help to seal water in the skin, relieving dryness and allowing the skin to heal. Educate patients to select fragrance-free and a heavy cream, ointment, or oil rather than a lotion. Direct patients to apply once a day at minimum and more often for very dry patches.
Scale softeners: As an active ingredient, salicylic acid, lactic acid and urea help to remove and soften scale and reduce swelling. It is especially common in treatment plans for scalp psoriasis or thick plaque-type psoriasis. By removing the scale, other topical products absorb more effectively. Over use of products with scale softeners may worsen psoriasis, causing dry, red, and itchy skin. To get the best results, it is often advised that patients take a warm, 15-minute bath before applying.
Prescription treatments include:
Corticosteroids: A corticosteroid may control mild or moderate psoriasis. When applied to the skin, redness, swelling, scaling, and itch are attenuated, often clearing psoriasis. Corticosteroids slow skin cell proliferation and are often used as part of a treatment plan for severe psoriasis.
Tazarotene: Tazarotene is a retinoid (a synthetic form of vitamin A) used to treat psoriasis as it can slow rapidly growing skin cells, reduce thick psoriasis, decrease the scale, and lessen redness and swelling. Also effective against nail psoriasis, tazarotene is often prescribed along with a corticosteroid, as combination therapy can reduce the irritation that often accompanies retinoid use. Multi phasic therapy often provides patients with longer-lasting results and remission periods.
| Type of Psoriasis | Compounded Formulas & Treatment Options |
|---|---|
| Plaque-type Psoriasis |
Localized topical therapy with:
Also consider generalized phototherapy, systemic agents, and combination therapy. |
| Guttate Psoriasis |
Ultraviolet B phototherapy (or natural sunlight) |
| Pustular Psoriasis, localized |
Topical therapy with formulas used for plaque-type psoriasis |
| Pustular Psoriasis, generalized |
Systemic therapy and/or hospitalization usually required |
| Erythrodermic Psoriasis |
Systemic therapy and/or hospitalization usually required |
VLS Pharmacy & New Drug Loft customize formulas tailored to clinical treatment plans. Our pharmacists work with prescribers to choose safe, well-studied and efficacious compounded solutions for patients struggling with many types of psoriasis. Typically, a topical formula is an essential part of a psoriasis treatment plan to provide instant relief from discomfort.
Other options include:
Allergen and preservative-free formulas
Topical, oral, and injectable steroids/corticosteroids
Antioxidant creams and serums
Coal tar preparations
Calcipotriene
Anthralin
Low-dose naltrexone (LDN) -- forms include capsules and sublingual troches 0.5-4.5 mg as well as topical creams and gels
If you are a prescriber, please complete the form below to receive a copy of our Preparation & Service Catalog
Please note: information on this site is not intended as medical advice and the medications listed are not specific to any individual. The content is intended to inform as to what may be possible. Listed medications and/or compounded formulas are not necessarily those compounded at VLS Pharmacy & New Drug Loft . Please speak with your prescribing clinician about your specific needs.
We commit to an extremely high level of accreditation and licensing in the industry.
*Only VLS Pharmacy holds this credential.
As a 503A pharmacy, VLS Pharmacy* is committed to providing high-quality formulations of sterile and non-sterile compounded medications to you and your patients. Thanks to rigorous testing measures, we guarantee the safety, stability, purity, sterility, and quality of each formulation from preparation to administration. We use high-quality, active pharmaceutical ingredients sourced directly from PCCA, the leader of superior-quality APIs. Additionally, our pharmacy network meets USP <795> non-sterile standards and USP <797> sterile compounding guidelines. We’re also proud to host one of the first pharmaceutical labs built to USP <800> standards for handling hazardous drugs.
All of our medications undergo third-party potency and stability testing, and we complete high-sensitivity rapid endotoxin detection on-site. These measures allow for shorter delivery times to the patient without compromising our product quality. Because we source all of our active ingredients from PCCA, we also promise an additional level of pre-formulation testing, as PCCA ingredients undergo 14 high-level checks and reviews in order to pass inspection.
*New Drug Loft is also a 503A compounding pharmacy but specializes in strictly non-sterile compounding and therefore abides by USP <795> only.
For almost three decades, our team has been committed to serving our network of physicians and patients. We appreciate the opportunity to share our expertise as we develop advanced compounded formulations for those who need and want more than what is commercially available. We work hard to achieve excellence in all areas of our business -- from investment and advancement to personalized customer service and rigorous in-house and third-party safety testing and quality assurance. We are proud to prove the best, individualized medical solutions, compounded as needed.
Our 503A pharmacy network specializes in providing custom-made sterile and non-sterile compounded medications to physicians and patients across the country. Each prescription is crafted and delivered with a commitment to the highest level of quality, safety and service.
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