Compounding Specialties

Acne

Acne, also known as Acne Vulgaris, is a common human skin disease, characterized by areas of skin with seborrhea(scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), nodules (large papules), pimples, and possibly scarring. Acne mostly affects skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms. The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation. In adolescence, acne is usually caused by an increase in testosterone, which accrues during puberty, regardless of sex. For most people, acne diminishes over time and tends to disappear, or at the very least decrease, by age 25. Some of the large nodules were previously called cysts and the term nodulocystic has been used to describe severe cases of inflammatory acne. The cysts, or boils that accompany cystic acne, can appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts. Cystic acne affects deeper skin tissue than common acne. Aside from scarring, Acne’s main effects are psychological, such as reduced self-esteem and in very extreme cases, depression or suicide. Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall long-term impact to individuals. Many patients have found our Acne cream to greatly help this skin disease.

Burns

Burns are an immediate and serious injury. Silvadene and Aloe have been used over time for immediate relief. ARX employs these historically proven agents, along with the addition of some specialty compounds.

Cold Sores

Cold sores, or fever blisters, are a type of the herpes simplex virus that occurs on the lips and mouth. An outbreak typically causes small blisters or sores on or around the mouth which generally heal within 2–3 weeks as the virus remains dormant. There are many products available that treat the symptoms of pain or moisturize. Our product combines the necessary drugs in one topical cream. Acyclovir and Deoxy-D-Glucose decrease viral replication; Camphor and Bupivacaine cause localized numbing at sight of pain; Oxybenzone and Dioxybenzone are sunscreens. Together, these products are put into a lip balm giving appropriate combination therapy, as well as consistent prevention of secondary cold sore formations.

Decreased Female Libido

Studies have reported that over 43% of the women in America experience little or no sexual satisfaction from orgasm and only 25% achieve orgasm during intercourse. Whether someone is multi-orgasmic or among the 43% of women who are sexually frustrated, any woman who desires maximum sexual fulfillment, greater intimacy, and enhanced relationships, stands to benefit from regular use of Libido Cream. This works by enhancing nitric oxide production in a woman’s sexual organs. Nitric oxide will draw blood into the genital area, which will cause the clitoris to be aroused and become highly sensitive. Orgasm happens when a completely aroused clitoris is correctly stimulated. Our bodies produce nitric oxide, which helps in blood circulation. In this process, the clitoris is properly engorged and the vagina is properly lubricated. The addition of the drug L-Arginine also results in an increase in blood flow and improved sexual response

Dermatitis

Dermatitis is a general term that describes an inflammation of the skin. Dermatitis can have many causes, occurs in many forms, and usually involves an itchy swollen rash on reddened skin that may blister, ooze, or develop a crust and flake. Generally, these different kinds share a common allergic reaction to specific allergens. The most frequent symptoms are dry, itchy, red skin; typically affecting the skin areas including the folds of the arms, the back of the knees, wrists, face, and hands. The first steps in treating Dermatitis is to identify the type of dermatitis you have and eliminate the cause, if possible. Mild skin inflammations usually respond to steroid creams to reduce inflammation and heal the irritation, as well as a corticosteroid. (Add an antihistamine to relieve severe itching. An antibiotic is applied if a secondary infection develops.)

•Seborrheic Dermatitis may respond to dandruff shampoos. These products may contain tar, salicylic acid, zinc pyrithione, ketoconazole, sulfur, or selenium, any of which may be effective.

•Contact Dermatitis caused by chemicals can be treated by avoiding the triggering chemical, along with medications to relieve symptoms such as antihistamines and corticosteroids, and other coping mechanisms.

•Nummular Dermatitis can be treated with moisturizing lotion and a prescription-strength corticosteroid cream.

Eczema

Eczema, often referred to as Atopic Dermatitis, is a form of chronic inflammation of the skin. The term Eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash. Eczema may affect any area of your skin, but it typically appears on the arms and behind the knees. It tends to flare periodically and then subside. The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and a malfunction in the body’s immune system.

Gout

GOUT (also known as Podagra when it involves the Big Toe) is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis – a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (approximately 50% of cases). Gout is also found in joints of fingers. It is primarily caused by elevated levels of Uric Acid in the blood. The uric acid crystallizes, forming needle-like crystalline structures in joints, tendons, and surrounding tissues.

Nail Fungus / Onychomycosis

Onychomycosis commercial products include Griseoflulvin, Itraconazole, Terbinafine and Ciclopirox 8% nail lacquer, known as (Penlac). Griseofulvin has reported poor cure rates and requires 10 to 18 months of use. Oral therapy with Itra conazole and Terbinafine also present problems with drug interactions and a very high potential for liver toxicity. A patient with compromised liver function or a GERD patient on a PPI will not be a candidate for oral Itraconazole. Having a specially formulated compounded product may overcome these problems and avoid the need for extensive liver monitoring; results may also occur faster. Nail fungus can be painful and cause permanent damage to nails. It may lead to other serious infections if the immune system is suppressed due to medications, diabetes, and other conditions.

DMSO SOLUTION:

We can dissolve an antifungal in dimethylsulfoxide or DMSO that has superior nail penetration and is able to deliver an antifungal to the site of infection. This formulation comes in a nail polish that is easily applied.

Nausea

Transdermal delivery of anti-emetics such as Ondansetron and Promethazine have several benefits. For instance, first pass metabolism and stomach degradation can be avoided and more consistent plasma levels can be maintained. In addition, topical administration can be an alternative to deliver medication when oral intake is limited due to nausea and vomiting. This could be of particular interest for pediatric patients who may have difficulties in frequency of administration, adverse taste, possibility of incomplete intake, difficulty in swallowing a pill, and fear of needles. There may also be a preference of interest for those patients frequently vomiting before a pill form has absorbed, such as morning sickness in pregnancy. The topical formulation of the drug has been found very competitive to both rectal suppositories and oral dosage forms in that variable blood levels, first-pass metabolism, unpredictable peaks in blood levels, and variable bioavailability may be minimized. Topical administration of these products has been reported to provide antiemetic relief to patients in need of treatment, while minimizing side effects and adverse reactions known to occur with many other formulations and routes of administration. These products are thought to work by coordinating with the vomiting center in the lateral medullary reticular formation in the pons. Chemicals in the cerebrospinal fluid and blood can have a direct stimulating effect at the vomiting center mediated through dopaminergic, cholinergic and histaminic neurochemical receptor sites. These pathways are antagonized by Odansetron, in which it blocks these neurochemical receptor sites by providing medication levels for treating or preventing the condition of emesis.

Neurology

Migraine, Tension Headache, Spasm Neurological issues can be serious and debilitating. Topical administration of neurological drug therapy is a new approach to treating such neurological conditions. This process appears to work by acting directly on nerve endings within the skin layers which relay impulses to the central nervous system, resulting in a therapeutic benefit through modulated impulses influencing the CNS impulses; possibly by axonal transport, significantly relieving the neurological condition. Within 5-10 minutes of application, many patients have reported receiving therapeutic benefits, with a duration of 4-12 hours, depending on the particular compound and disease state or symptom. Topical therapy also is a great benefit for these neurological drugs due to the reduction of drug interactions and side effects, as well as keeping therapy localized and non-systemic.

Like many products, the true mechanism by which these neuropathic drugs act has not been completely established.

Pain

Pain Management is essential because even when the underlying process is stable, uncontrolled pain prevents patients from working productively or enjoying the normal rhythm of life. Pain disruption can affect sleep, concentration, induce drowsiness, and much more. Chronic pain may have a range of causative factors and therefore can be much more difficult to manage than acute pain, requiring multiple approaches and customized treatment protocols to meet the specific needs of each patient. Optimal treatment may involve the use of medications that possess pain-relieving properties, including antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. NMDA antagonists, such as Amantadine and Ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and may decrease the need for opioids. By combining various agents which utilize different mechanisms to alter the sensation of pain, commonly smaller concentrations of each medication can be used. Topical and transdermal creams and gels can be compounded and formulated to provide high local concentrations at the site of application. Side effects associated with oral administration can often be avoided when medications are used topically. These side effects from oral pain medications may include: GI irritation, liver damage, kidney problems, drowsiness, constipation, and more. Over 56,000 emergency room visits are made each year just from over-the-counter oral pain remedies. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded product. When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism, which can greatly reduce certain drug interactions and negative side effects. Using a topical makes application easy and controllable as well as onset of relief may be seen faster than oral preparations. Formulations penetrate through the skin to produce effects in the tissues underneath while avoiding many systemic side effects.

Postherpetic Neuralgia

POSTHERPETIC NEURALGIA (PHN) is a nerve pain due to damage caused by the Varicella Zoster Virus. Typically, the neuralgia is confined to a dermatomic area of the skin and follows an outbreak of herpes zoster (HZ, commonly known as Shingles). Neuralgia typically begins when the HZ vesicles have crusted over and begin to heal. Postherpetic neuralgia is thought to be nerve damage caused by herpes zoster. The damage causes nerves in the affected area to send abnormal electrical signals to the brain which may convey excruciating pain and may persist or recur for long periods of time.

Psoriasis

Psoriasis is an immune-mediated disease that affects the skin. It is typically a lifelong condition. There is currently no cure, but various treatments can help to control the symptoms. Psoriasis occurs when the immune system mistakes a normal skin cell for a pathogen and sends out faulty signals that cause overproduction of new skin cells. It is not contagious. Psoriasis has been linked to an increased risk of stroke, and treating high blood lipid levels may lead to improvement. There are five types of psoriasis: plaque, guttate, inverse, pustular, and erythrodermic. The most common form, plaque psoriasis, is commonly seen as red and white hues of scaly patches appearing on the top first layer of the epidermis (skin). In plaque psoriasis, skin rapidly accumulates at these sites, which gives it a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area, including the scalp, palms of hands, and soles of feet. In contrast to eczema, psoriasis is more likely to be found on the outer side of the joint. There are many treatments available, but because of its chronic recurrent nature, psoriasis is a challenge to treat. Patient feedback has indicated that our Psoriasis cream has been successful in greatly reducing their Psoriasis while correspondingly improving their quality of life.

Radiation Exposure

Radiation exposure can cause significant damage to the skin. The types of greatest concern are thermal radiation, radio frequency energy, ultraviolet light and ionizing radiation. Most commonly, is it causes a type of sunburn to the skin. ARX’s Radioprotective cream may help shield patients from exposure while greatly diminishing any burning of the skin, as well as reducing the inflammation associated with this process.

Rectal Pain

Anal Fissures

An Anal Fissure is a tiny tear causing a linear ulcer to form at the boundary of the anus. Anal fissures cause itching, pain, and bleeding. Anal fissures cause pain during bowel movements that can last for hours on end.They are caused sometimes by extreme constipation as well as diarrhea. If constipated, the passage of hardened and dry stool may cause some tearing on the anal lining. Fissures can also be caused during diarrhea by frequent wiping of the inflamed or swollen area of the anal canal. A diet rich in high fiber, combined with drinking 8-10 glasses of water every day, can help in promoting healthier bowel movements while curtailing further damage to anal tissue. Nifedipine 2%, Lidocaine 1.5%

Hemorrhoids

Hemorrhoids can also cause rectal pain, itching, burning, and bleeding. Hemorrhoids are usually swollen veins found in the lower rectum and around the anal canal. Hemorrhoids are usually classified as internal or external. The usual causes of hemorrhoids can be constipation or diarrhea due to excessive straining and wiping during bowel movements. Hemorrhoid treatment usually includes over-the-counter ointments and creams, as well as suppositories. One can also use natural remedies available in oral and ointment forms which, when used together, can prove to be a moderately effective alternative.

Rosacea

Rosacea is a chronic condition characterized by facial erythema (redness) and sometimes pimples. Rosacea affects all ages and has four subtypes, three affecting the skin and the fourth affecting the eyes (ocular type). Left untreated it worsens over time. Treatment in the form of topical steroids can aggravate the condition. It affects both sexes, but is almost three times more common in women and has a peak age of onset between 30 and 60. Rosacea typically begins as redness on the central face across the cheeks, nose, or forehead, but can also less commonly affect the neck, chest, ears, & scalp. In some cases, additional symptoms, such as semi-permanent redness, telangiectasia (dilation of superficial blood vessels on the face), red domed papules (small bumps) and pustules, red gritty eyes, burning and stinging sensations, and in some advanced cases, a red nose (rhinophyma) may develop.

Treatments:

Topical antibiotics such as Metronidazole are usually the first line of defense prescribed by doctors to relieve papules, pustules, inflammation and some redness. Topical Briminidone may help reduce inflammatory lesions, bumps and papules. If papules and pustules persist, then sometimes Tretinoin can be prescribed. Tretinoin has many side effects and is normally used to treat severe acne, but in low dosages is proven to be effective against papulopustular and phymatous rosacea. Some individuals respond well to the topical application of Tranilast or other antihistamines on the affected area, particularly in reducing the prevalence of redness.

Scar

Post Surgical Scars, New and Old Scars, Keloids, Hyperpigmented Scars, Acne Scars, Stretch Marks Scars are areas of fibrous tissue (fibrosis) that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body; thus scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. Scar tissue is exactly the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different. Instead of a random basket-weave formation of the collagen fibers found in normal tissue, in scarring, the collagen cross-links and forms a pronounced alignment in a single direction. This alignment is usually of inferior functional quality to the normal collagen randomized alignment. For example, scars in the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissues.

Shingles

Herpes Zosterb (or simply Zoster), commonly known as Shingles, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. The initial infection with Varicella Zoster virus (VZV) causes the acute, short-lived illness Chickenpox which generally occurs in children and young adults. This infection can lie dormant for many years until it resurfaces in adults.

Vulvodynia

VULVODYNIA is a chronic pain syndrome that affects the vulvular area of the external genital female organs, including labia majora, labia minora, clitoris, and vestibule of the vagina. The syndrome often occurs without an identifiable cause or visible pathology. It presents mostly as pain in the form of burning, stinging, irritation or sharp pain occurring in the vulva, including the labia and entrance to the vagina. This pain may be constant, intermittent, or trigger in response to touch. It has been found to cause painful intercourse. Vulvodynia can sometimes even last for years. Treatment other than injection or topical is limited for this increasingly common problem.

Warts

A wart is a small, rough growth resembling a cauliflower or a solid blister. It typically occurs on humans’ hands or feet but often in other locations. Warts are caused by a viral infection, specifically by one of the many types of human papillomavirus (HPV). There are as many as 10 varieties of warts, the most common considered mostly harmless. It is possible to get warts from others; they are contagious and usually enter the body in an area of broken skin and typically disappear after a few months, but can last for years and can recur. Viruses such as Human Papillomavirus (HPV) causes focal areas of epithelial hyperplasia, referred to as warts. No standard and routinely

effective treatment for warts exists. Most warts, if left without treatment, spontaneously regress over a period of many months to years. Local treatments that should be considered are cryotherapy, application of (5-FU) or Fluorouracil cream, application of keratolytic agents (Salicylic Acid), cut removal, and laser ablation.

Wound

Healing Promotion, Gram Positive Bacteria, Gram Negative Bacteria, Fungal Infections, and MRSA ARX customizes preparations to treat a variety of wounds and skin ulcers to improve therapeutic outcomes, reduce side effects, and save patients time and money. Our Spira Wash and Pracasil gels and creams deliver the medication to the wound site in an easier, more pleasant and potentially more effective manner. Multiple medications that have been shown to have modest effects individually are combined to form a more potent custom ized blend. Result: The wound healing process is frequently accelerated with a corresponding decrease in discomfort.

SPIRA WASH GEL BASE:

Spira-Wash Gel is a base designed to promote a moist wound envi ronment to promote the healing process. It is a soft, opaque Polyethylene Glycol (PEG) ointment base containing organic meadowsweet extract. Due to the phenolic glycosides (spiraein) and flavonoids in the meadowsweet, it potentially has germicidal, anti-inflammatory and healing properties, thus making it a favorable choice for wounds, ulcers, burns, sores, and cuts. Ointments that are not water soluble often present a challenge to wound care patients and practitioners; Spira-Wash Gel may be a welcome option. Spira-Wash Gel is a water-washable base for easy cleansing/debridement. It is adherent, provides occlusion, and maintains a moist environment at the wound/dressing interface.