Wound Care

wound careAt PharmacyMax Labs, we offer wound care solutions to patients with difficult to heal
injuries.

Wound care compounding involves several approaches and medications applied
topically. Some of the medications are designed with the goal of stimulating new tissue
growth, reducing pain, and discouraging bacterial overgrowth, while others are designed
to increase blood flow to the wound and are applied to the skin that borders the wound.

We also recommend these medications for patients who do not have wounds, but who
have very poor circulation to a toe, foot, or leg. If you have a wound that is difficult to
heal, or a limb with poor circulation, do not hesitate to contact us. We can provide you
and your doctor with more information about our wound treatment protocols.
Medications to improve capillary blood flow can be added to a compounded medication
to enhance circulation at the wound margins and promote healing of the injured area,
and Decubitus ulcers, venous stasis and diabetic ulcers, traumatic wounds, and burns
may heal more quickly if treated topically with phenytoin. Topical anesthetics can be
added to relieve pain.

Prescription Compounds
Wound Care compounds consists of the following components: Wound type,
Medication, Base choices.

Wound care formulations can be compounded to contain the proper combination of active ingredients, in the most appropriate of wounds. We customize medications to
meet each individual’s specific needs. The pirate base is used to treat a specific ty.

The choice of cream, ointment, or gel can be clinically significant. Each time a
wound needs to be cleaned, there is the potential for disruption of new tissue growth.
Gels, which are more water soluble than creams or ointments, may be preferable for
wound use because a gel can be rinsed from the wound by irrigation. Ointments may
contain polyethylene glycol (PEG), which can be absorbed from open wounds and
damaged skin. If the wound is quite large and too much PEG is absorbed, it can lead to
renal toxicity.

Another useful dosage form is the “polyox bandage” – which can be puffed onto a
wound and will adhere even if exudate is present. A polyox bandage can be
compounded to contain the active ingredient(s) of your choice.

Compounding for wound care applications include:

  • Decubitus Ulcers
  • Venous Stasis and Diabetic Ulcers
  • Traumatic Wounds
  • Skin Autograft Donor Sites
  • Puncture wounds, lacerations, or a combination of both
    Burns

Sunscreens
A sunscreen or sun block such as micronized zinc oxide can be added to topical
formulations to decrease the potential for photosensitivity reactions.  This may be
particularly important if a preparation also contains pharmaceutical ingedients that can
cause photosensitivity.

Barrier creams
Barrier creams can be formulated to minimize development of contact dermatitis, as
part of an incontinence skin care protocol, or to treat severe diaper rash.

Wound Healing and Circulation Improvement 
Nifedipine has been used in concentrations of 0.2% to 10% PLO gel in an effort to
enhance circulation in areas of ischemia. Higher concentrations are used by
pharmacists, but the lower doses are a better starting point due to the hypotensive
properties of this drug. The same vaso-dialation properties that make it work well orally
in diseases such as hypertension, angina pectoris, and Raynaud’s syndrome could also
make it work well as an agent to rub on areas around diabetic ulcers and in ischemic
areas to aid in blood flow. Transdermal nifedipine PLO should be dispensed in an
amber bag because of its light sensitivity. The patient should be monitored for
decreased blood pressure while using the preparation, and the wound should be
monitored for signs of healing (skin becoming more pink, vascularized and skin dryness
around the wound.

Possible formulas:

  • Nifedipine 4-16% transdermal
  • Pentoxifylline 5% Lipoderm

Onychomycosis – nail fungus
Commercial products to treat onychomycosis include griseoflulvin, itraconazole,
Terbinafine and circlopirox 8% nail lacquer (Penlac). Griseofulvin has reported poor
cure rates and requires 10 – 18 months of use.  Oral therapy with itraconazole and
Terbinafine also present problems with drug interactions and liver toxicity.  A patient
with compromised liver function or a GERD patient on a PPI will not be a candidate for
oral itraconazole.  For patients who cannot use antifungals, Penlac is the only
commercial topical treatment available.  However, Penlac reportedly has only a 14%
cure rate after several months of use. Having a compounded prescription medication
may overcome these problems and avoid the need for extensive liver monitoring.  We
can dissolve an antifungal in dimethylsulfoxide (DMSO) that has superior nail
penetration and it is able to deliver an antifungal to the site of infection. Examples of
antifungals that can be compounded in DMSO are azole antifungals and terbinafine.
Possible formulas:

  • Itraconazole 1%/Ibuprofen 2% in DMSO nail polish
  • Itraconazole 1%/Undecylenic Acid 17% in Tea Tree Oil-DMSO nail polish
  • Itraconazole 1%/Undecylenic Acid 17%/Salicylic Acid 10% in Tea Tree Oil-
    DMSO nail polish
  • Ketoconazole/Tea Tree Oil/DMSO  Antifungal Solution
  • Terbinafine 1.67% Topical Solution

Diabetic Neuropathy
There are numerous medications that are commercially available to treat diabetic
neuropathy and help return sensitization.  Some of the drugs used to treat diabetic
neuropathy are amitriptyline, baclofen, ketamine, gabapentin, and clonidine.  Diabetic
patients can benefit from topical combinations of these medications that are not
commercially available. Combinations of topical medications have the advantage of
fewer adverse effects as well as using one medication rather than several.
Possible formulas:

  • Baclofen 5%/Ketoprofen 10%/Lidocaine 5%/Gabapentin 5% transdermal
  • Ketamine 10%/Gabapentin 6%/Clonidine 0.2%/Lidocaine 2% transdermal
  • Ketamine 10%/Gabapentin 6%/Clonidine 0.2%/Nidedipine 2% transdermal
  • Gabapentin 6%/Clonidine 0.2% transdermal
  • Clonidine 0.2%/Gabapentin 6%/Ketamine 10% transdermal

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