Innovative Treatments in Dermatology

Transcription

1 Innovative Treatments in Dermatology Personalized Medicine provides additional tools to optimize patient care 2018 Slyngshot Health

2 Slyngshot Health Slyngshot Health is revolutionizing personalized medicine by connecting medical providers, pharmacies, and patients on a single network with continuous access to educational resources, best in class compounding pharmacies, and robust technology; with the goal to drive better care and outcomes. contact@slyngshothealth.com 2

3 Dr. Sahar Swidan Pharm.D., BCPS, ABAAHP, FAARFM, FACA 2018 Slyngshot Health 3

4 Staying as healthy as possible for your age and skin 4

5 5 Major Health Areas That Affect Your Skin 5

6 5 Major Health Areas That Affect Your Skin Stress Gut / Brain Chemistry Inflammation Sleep Hormonal Balance 2018 Slyngshot Health 6

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8 Sleep Energy Pain Cravings Thoughts 8

9 Gut 9

10 The effect of inflammation 10

11 Energy Thieves - Oxidative Stress When your body generates energy = more toxins or waste products are produced 11

12 The effects of a bad nights sleep 12

13 36% of adults seeing a primary care doctor always feel tired Schmidt, M., Tired of Being Tired, Berkeley, CA: Frog, Ltd.,

14 In a Nutshell ATP Energy - may be a fountain of Youth ATP Cannot be taken as a pill ATP Needs to have the ingredients to make it ATP Can be both a Prevention and Treatment ATP Improved quality and longevity of life 14

15 Always remember to RE-FUEL 15

16 Hormones and their effects on healthy aging

17 A hormone is a messenger 17

18 Hormones Affecting Skin Health Estrogen Pregnenolone Testosterone Insulin DHEA Cortisol Thyroid Melatonin Progesterone Growth Hormone 18

19 Role of Hormones in Skin With menopause and andropause, our bodies hormones lose the ability to communicate due to lower circulating levels Hormone miscommunication causes imbalances leading to: Excess blood glucose which destroys collagen Excessive free radicals leading to oxidative damage in cells Increased insulin resistance Increased cortisol levels Decreased immune function 19

20 Women & Aging Average female life expectancy: 81.6 years Average onset of menopause: 50 years More women live in hormone-deprived state for longer time period (30 years) 20

21 Effect of Systemic Estrogen on Skin Thickness & Collagen Study Type of measurement Hormone dose Treatment duration Outcome Maheaux et al. Ultrasonography Conjugated estrogens mg Callens et al. Skin ultrasonography Estradiol gel or transdermal patches 1.5 mg Sauerbronn et al. Skin biopsy analysis Estradiol valerate 2 mg, cycled with cyproterone acetate 1 mg 12 mo Skin thickness increased by 11.5% Median of 4.8 yr Skin thickness increased by 7-15% 6 mo Skin collagen increased by 6.49% Sator et al. Sebumeter, Corneometer, high frequency ultrasound Estradiol 2 mg/ dyhydrogesterone 10 mg 7 mo Significant increase in skin elasticity, hydration, thickness Savvas et al. Skin biopsy analysis Estradiol 50 mg; testosterone subcutaneous implants 100 mg Median of 8 yr Significantly higher skin collagen type III Castelo-Branco et al Skin biopsy analysis Conjugated estrogens mg or trans-dermal estrogen patch 12 mo Skin collagen increase by % 21

22 Personalized Medicine is the Future 22

23 The Value of Compounding 23

24 Compounding is The preparation, mixing, assembling, packaging, or labeling of a drug or device (i) as a result of a practitioner s prescription drug order or initiative based on the Practitioner / Patient / Pharmacist relationship in the course of professional practice, or (ii) for the purpose of or as an incident to research, teaching, or chemical analysis, and not for resale or dispensing. Compounding also includes the preparation of drugs or devices in anticipation of prescription drug orders based on routine, observed patterns. 24

25 Compounding (continued) Focuses on providing innovative patient care through the use of unique dosage forms, alternative therapies, and specialized education and equipment. The ultimate goal in preparing customized medications is to help the physician and patient achieve a more positive therapeutic outcome. 25

26 Compounding Opportunities A way to gain access to necessary medications Not duplicating products currently on the market in compliance with state & federal regulations Different dosage form/delivery system Unless temporarily unavailable Combinations-added clinical value 26

27 It s all about dat base, bout dat base! The chemical characteristics of the base will have a huge impact on the quality and efficacy of the compound Ceramides help the barrier, petrolatum is a barrier Commercial cosmetic creams are generally not designed to hold additional ingredients, while good compounding bases are. 27

28 Better ingredients Quality is key Cheapest price may not get you the best compound Formulation Verification 28

29 How much?- No Really??? The price of prescription dermatologic drugs rose considerably from 2009 to 2015, with the vast majority of price increases occurring after Percent increases for multiple, frequently prescribed medications greatly outplaced inflation, national health expenditure growth, and increases in reimbursements for physician services JAMA Dermatol Feb;152(2): doi: /jamadermatol Changes in Retail Prices of Prescription Dermatologic Drugs From 2009 to Rosenberg ME, Rosenberg SP. 29

30 Seriously??? Prices of topical anti-neoplastic drugs had the greatest mean absolute and percentage increase (1240%) Prices of drugs in the anti-infective class had the smallest mean absolute increase Psoriasis medications had the smallest mean percentage increase (180%) JAMA Dermatol Feb;152(2): doi: /jamadermatol Changes in Retail Prices of Prescription Dermatologic Drugs From 2009 to Rosenberg ME, Rosenberg SP. 30

31 Acne Preps VELTIN or ZIANA gel (Clindamycin 1.2%/Tretinoin 0.025% Gel) Brand $365 for 30 gm Generic $338 for 30 gm Other ingredients: butylated hydroxytoluene, carbomers, citric acid, distilled water, edetate disodium, glycerin, methylparaben, polysorbate 80, propylparaben, tromethamine Clindamycin1% /Tretinoin 0.025% Topical Cream (ClarifyingTM) 31

32 XERESE (Acyclovir/Hydrocortisone) Acyclovir 5%/ Hydrocortisone 1% Brand Cream pharmacy cost $1000/5gm (no generic) Other Ingredients: cetostearyl alcohol, citric acid, hydrochloric acid, isopropyl alcohol, mineral oil, poloxamer 188, propylene glycol, sodium hydroxide, sodium lauryl sulfate, water, white petrolatum base Acyclovir 5%/ Hydrocortisone 1%/Lidocaine 2% Topical Cream (VersaBase ) Acyclovir 5%/Lidocaine 2%/ Hydrocortisone 2.5% Topical Cream (VersaBase ) 32

33 Alcortin A Hydrocortisone Acetate 2%, Iodoquinol 1%, Aloe Polysaccharide 1%, Topical gel Possibly Effective: mycotic dermatoses such as tinea (capitis, cruris, corporis, pedis) $3500 (24 x 2 gm packets) Hydrocortisone Acetate 2%, Iodoquinol 1%, Aloe Polysaccharide 1%, Topical Gel 33

34 Alcortin A Other Ingredients: aminomethyl propanol, benzyl alcohol, carbomers, distilled water, FD&C Blue No.1, FD&C Yellow No.10, glycerin, hydrochloric acid, magnesium aluminum silicate, palmitoyl oligopeptide, PPG-20 methyl glucose ether, propylene glycol, SD alcohol 40B Hydrocortisone Acetate 2%/Iodoquinol 1%/Aloe 0.5%/Tea Tree Oil 1% Topical Gel 34

35 Compounding Options for Patients With Eczema, Psoriasis or Dry Skin 35

36 Meet XemaTop Designed for use in compounding formulations for patients with eczema, psoriasis and xerosis Uses the natural synergy of boswellic acid, avenanthramides from oats, and phosphatidyl glycerol 36

37 Formulas for patients with eczema, dry skin, or psoriasis Cyanocobalamin 0.07% Topical Cream Doxepin HCl 0.5%/Naltrexone HCl 0.1% Topical Cream Tacrolimus 0.1%/Ketotifen 0.05% Topical Cream Coal Tar Topical Solution 5%/Salicylic Acid 6%/Clobetasol Propionate 0.05% Topical Cream Zinc Pyrithione 0.2%/Clobetasol Propionate 0.05%/Cyanocobalamin 0.07% Topical Cream 37

38 Atopic Dermatitis (AD) Fluticasone 0.05%/ Naltrexone 0.1% Topical Cream (XemaTop) Ketotifen 0.05%/Cyanocobalamin 0.07% Topical Cream (XemaTop) Mast cells are believed to be Involved in the pathogenesis of atopic dermatitis Curr Opin Immunol Dec;21(6): Mast cells in atopic dermatitis. Kawakami T, Ando T, Kimura M, Wilson BS, Kawakami Y. 38

39 Montelukast Our observations proved that montelukast as a prospective corticosteroid-sparing option in the complex therapeutic strategy of corticosteroid-dependent atopic dermatitis patients, even in the severe erythrodermic cases Dermatol Ther Jan-Feb;23(1):90-3. Therapeutic Hotline: Cysteinyl leukotriene receptor antagonist montelukast in the treatment of atopic dermatitis. Broshtilova V, Gantcheva M. 39

40 Atopic Dermatitis (AD) Montelukast 1%/ Ketotifen 0.05% Xematop cream Apply BID to affected area(s) 40

41 Age Management Anti-aging Hormones Estriol 0.1% cream Vitamin C ester Facial peels Glycolic Acid Peels 10-20% pads Alpha lipoic acid 0.5% Good combo: Lipoic Acid 0.5%/CoQ10 0.3%/Estriol 0.1% in Versabase Cream Pomegranate Seed Oil 1.6%/Acetyl-D-Glucosamine 5% Compound Topical Cream Skin Renew Cream 41

42 Azelaic Acid Cosmetic Azelaoyl Diglycinate 15%/ESTRIOL 0.1%/TRETINOIN 0.025% IN NOURISH cream base Acetyl Hexapeptide 3-10%/Glycosaminoglycans/CoQ % in NOURISH cream base Azelaoyl Diglycinate 15%/ Niacinimide 5% Topical Cream (Clarifying TM ) Potassium azeloyl diglycinate, obtained by reacting the chloride of azelaic acid with two molecules of glycine and KOH, is a new generation ingredient 42

43 Acne Acne vulgaris Azelaic Acid 10%-20% Niacinamide 4% Spironolactone 0.1% Zinc 0.1% Most common Azelaic Acid 10% with Niacinamide 4% cream in Clarifying Base Apply one to two times daily 60 gram jar for a one month supply 43

44 Acne Niacinamide 4%/Biotin 0.1%/Lipoic Acid 0.5% Topical Gel Acetyl-D-Glucosamine 2%/Niacinamide 5%/Potassium Azeloyl Diglycinate 8% Topical Cream Niacinamide 5%/Biotin 0.1%/Potassium Azelaoyl Diglycinate 6% Topical Gel 44

45 Acne Preps Indicated for topical application in the treatment of acne vulgaris in patients 12 years and older Clindamycin 1%/Niacinamide 2% topical foam Niacinamide significantly lowered sebum secretion rate J Cosmet Laser Ther Jun;8(2): The effect of 2% niacinamide on facial sebum production. Draelos ZD, Matsubara A, Smiles K. 45

46 The Polyox Bandage Superior oral bandage Stays in place for hours even if rubbed Used for any drug therapy desired Antihistamine, anesthetic, antiviral, antifungal, anti-inflammatory, etc., or combinations HC 1%/Lidocaine 1% Also used for oozing wound care No touching of wound for application No removal of new growth 46

47 Tackling dermatologic issues early allows for a healthier and happier aging process. 47

48 Dr. Sahar Swidan, Pharm.D., BCPS, ABAAHP, FAARFM, FACA Dr. Swidan received her Doctor of Pharmacy degree and completed a 3-year research Fellowship in Bio-Pharmaceutics and Gastroenterology at the University of Michigan. Currently, she is completing a Master s program in Cardio-Metabolic and Functional Medicine. Dr. Swidan is board certified, an advanced fellow in anti-aging and regenerative medicine, and an internationally renowned speaker in the areas of pain management, headaches, and BHRT. She has authored several book chapters, articles, and patient education material in pain management and functional medicine. Previously, she was Director of Pharmacy at Chelsea Community Hospital and the clinical pharmacist for the inpatient head and chronic pain service. Dr. Swidan holds several concurrent roles. She is Executive Director - Professional Development and Compliance for Slyngshot Health, President and CEO of Pharmacy Solutions in Ann Arbor, MI, Adjunct Associate Professor of Clinical Research and Leadership at George Washington University School of Medicine and Health Sciences, and Adjunct Clinical Associate Professor of Pharmacy at Wayne State University and Chicago State University. 48

49 Questions? 49