Can Compounding Pharmacists Help Reduce the Effect of Post-Inflammatory Hyperpigmentation in Darker-Skinned Individuals?
In 2012, the cosmetic industry in the U.S. was valued at $56.63 billion, with facial skin care representing the largest component of the industry 1 However, for a minority of individuals with Fitzpatrick skin phenotypes III-IV 2, post inflammatory hyperpigmentation (PIH) can make achieving clear skin especially difficult. PIH occurs when inflammatory processes in the skin are activated following an injury, infection or even acne, resulting in permanent skin disfigurement and/or discoloration. Though individuals of all skin colors can experience PIH, it is most often seen in individuals with darker skin colors and are often of African American, Hispanic, Asian, Native American or Middle Eastern descent. Unsurprisingly, PIH has been strongly associated with psychosocial distress and anxiety in those with the disorder, but current treatments for PIH are mostly limited to cosmetic options applied after discoloration has already occurred. In this milieu, compounding pharmacists can play an essential role in developing novel, tailored treatments to prevent PIH.
Molecular Mechanisms of PIH
Despite the relatively widespread incidence of PIH, the molecular mechanisms that underlie the condition are poorly understood. Still, researchers believe that two major processes are involved: pigment incontinence and increased melanin production. Pigment incontinence occurs because of inflammation-induced damage to keratinocytes following the disruption of the basal cell layer. The released pigment is then phagocytosed by macrophages in the upper dermis (which are then called melanophages), thus contributing to skin discoloration. In terms of melanin production, inflammatory mediators can directly stimulate the production of melanin by melanocytes, which further contributes to skin discoloration following injury. Taken together, the interactions between pigment cells and immune cells are believed to make the skin especially vulnerable to developing pigmentation problems.
Current Therapies: Too Little, Too Late?
Compounding pharmacists are likely very familiar with current treatments of PIH and are thus aware that such therapies are often limited to treating patients after they present with skin hyperpigmentation. Currently, PIH treatments fall into two categories: treatments that attempt to remove the skin discoloration caused by PIH and those meant to regulate melanin production.
Removal of hyperpigmentation is often done using chemical (e.g. chemical peels) or physical agents (e.g laser-therapy, intense pulse light). These therapies work by removing the layer of hyperpigmented skin in order to allow new cells to regenerate; however, these treatments can be expensive and can even worsen PIH by further traumatizing skin cells. Furthermore, in darker-skinned individuals, PIH can occur in deep layers of the skin, which are unreachable with surface treatments.
Chemical peels and light-based treatments are often completed in a dermatologist’s office; however, compounding pharmacists are familiar with topical agents and remedies used to inhibit melanin production or improve skin pigmentation, the second category of treatment. These topical agents often include mixtures of hydroquinone, arbutin, a variety of acids (e.g. retinoic acid, lactic acid), tretinoin and resorcinol in various concentrations. Most importantly, compounding pharmacists can work with patients and their healthcare providers to develop tailored therapies 3 to treat skin discoloration.
The Role of Compounding Pharmacists in Treating PIH Sufferers
Ultimately, researchers and physicians agree that PIH is caused by the negative interactions between inflammatory pathways and melanin, and though much is still unknown, as with other conditions, compounding pharmacists have a unique role to play in the treatment of PIH, both in terms of social outreach and developing novel therapeutic interventions.
Social Outreach: To begin with, individuals go to pharmacists with a myriad of questions after they’ve injured themselves or to purchase over-the-counter remedies for burns or infections. In this context, compounding pharmacists can identify those most likely to develop PIH and thus inform them of the disorder, while providing advice on properly treating the patient’s underlying medical problem (e.g. infection, burn).
Additionally, researchers believe that sun exposure can increase the chance of developing PIH or that the condition worsens. Along the lines of social outreach, compounding pharmacists can create special SPF formulations compounded into an individual’s preferred moisturizers in order to increase adherence, while protecting an individual’s skin from skin discoloration.
Therapeutic Interventions: In the context of novel therapeutic interventions, compounding pharmacists can formulate topical creams that decrease the risks of skin injury by dampening the skin’s inflammatory response. For example, for individuals who present with skin injuries, steroidal and nonsteroidal anti-itch therapies can be specially formulated with camphor and menthol in order to control itching and decrease the likelihood of scratching-induced skin damage. Such interventions that address the problem of inflammation can go a long way toward reducing the number of expensive therapeutic options an individual with PIH might pursue later, if they have to pursue any at all.
Moving Forward with Pharmacist-Inspired Treatments for PIH
PIH is a long-lasting skin condition, which when left untreated or when improperly treated, can worsen overtime. Unfortunately, sufferers of PIH often experience depression and anxiety because of the damage visible on the surface of their skins. In order to improve outcomes for these patients, pharmacists should take a greater role in compounding ingredients that decrease the likelihood that injuries result in PIH to the benefit of millions of individuals.
If you are a compounding pharmacist interested in developing novel topical creams to both prevent or treat PIH, Pharmaceutica North America has been providing high-quality active ingredients and pharmaceuticals since 2009. Please contact us today to determine how we can help you provide the best care for your patients.
- “Breakdown of the cosmetic industry sales in the United States in 2011, by product category,” June 2012, http://www.statista.com/statistics/243851/breakdown-of-the-cosmetic-industry-in-the-us-by-product-category/ ↩
- “Postinflammatory Hyperpigmentation: A Review of the Epidemiology, Clinical Features, and Treatment Options in Skin of Color,” July 2010, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921758/ ↩
- “Help Prevent and Reverse Postinflammatory Hyperpigmentation,” May/June 2011, http://bmctoday.net/practicaldermatologypeds/pdfs/Peds0611_PedSkincare.pdf ↩