Dermatological Products Research Articles

Nanoparticles for Topical Application in the Treatment of Skin Dysfunctions-An Overview of Dermo-Cosmetic and Dermatological Products.

Nanomaterials (NM) arouse interest in various fields of science and industry due to their composition-tunable properties and the ease of modification. They appear currently as components of many consumer products such as sunscreen, dressings, sports clothes, surface-cleaning agents, computer devices, paints, as well as pharmaceutical and cosmetics formulations. The use of NPs in products for topical applications improves the permeation/penetration of the bioactive compounds into deeper layers of the skin, providing a depot effect with sustained drug release and specific cellular and subcellular targeting. Nanocarriers provide advances in dermatology and systemic treatments. Examples are a non-invasive method of vaccination, advanced diagnostic techniques, and transdermal drug delivery. The mechanism of action of NPs, efficiency of skin penetration, and potential threat to human health are still open and not fully explained. This review gives a brief outline of the latest nanotechnology achievements in products used in topical applications to prevent and treat skin diseases. We highlighted aspects such as the penetration of NPs through the skin (influence of physical-chemical properties of NPs, the experimental models for skin penetration, methods applied to improve the penetration of NPs through the skin, and methods applied to investigate the skin penetration by NPs). The review summarizes various therapies using NPs to diagnose and treat skin diseases (melanoma, acne, alopecia, vitiligo, psoriasis) and anti-aging and UV-protectant nano-cosmetics.

Mechanistic modeling of drug products applied to the skin: A workshop summary report.

The development of a generic drug product involves demonstrating that there is no significant difference in the rate and extent to which the active ingredient becomes available at the site of action, relative to the reference listed drug product. This remains challenging for many locally acting topical dermatological products because measuring the concentration of the active ingredient at the site of action in the skin may not be straightforward, and, in most instances, there are no established relationships between skin and plasma pharmacokinetic profiles. In recent years, the Office of Generic Drugs of the US Food and Drug Administration (FDA) established scientific research programs with the goal of enhancing patient access to high quality, affordable topical dermatological generics. A key strategy of these research programs was to leverage modeling and simulation methodologies that accelerate the development of these generics by facilitating alternative bioequivalence approaches for dermatological drug products. This report summarizes relevant insights and discussions from a 2021 FDA public workshop titled "Regulatory Utility of Mechanistic Modeling to Support Alternative Bioequivalence Approaches," which illustrated how mechanistic modeling and simulation approaches can be utilized (and have been used) to inform generic drug product development and regulatory decisions during the assessment of generic drug applications submitted to the FDA.

A mechanistic physiologically based model to assess the effect of study design and modified physiology on formulation safe space for virtual bioequivalence of dermatological drug products.

Physiologically based pharmacokinetic (PBPK) models are widely accepted tools utilised to describe and predict drug pharmacokinetics (PK). This includes the use of dermal PBPK models at the regulatory level including virtual bioequivalence (VBE) studies. The current work considers the Topicort® Spray formulation, which contains 0.25% desoximetasone (DSM), as an example formulation. Quantitative formulation composition and in vitro permeation testing (IVPT) data were obtained from the public literature to develop a mechanistic model using the multi-phase, multi-layer (MPML) MechDermA IVPT module in the Simcyp Simulator. In vitro-in vivo extrapolation functionality was used to simulate in vivo PK for various scenarios and predict a 'safe space' for formulation bioequivalence using the VBE module. The potential effect of vasoconstriction, impaired barrier function, and various dosing scenarios on the formulation safe space was also assessed. The model predicted 'safe space' for formulation solubility suggesting that a 50% change in solubility may cause bio-in-equivalence, whereas viscosity could deviate by orders of magnitude and the formulation may still remain bioequivalent. Evaporation rate and fraction of volatile components showed some sensitivity, suggesting that large changes in the volume or composition of the volatile fraction could cause bio-in-equivalence. The tested dosing scenarios showed decreased sensitivity for all formulation parameters with a decreased dose. The relative formulation bioequivalence was insensitive to vasoconstriction, but the safe space became wider with decreased barrier function for all parameters, except viscosity that was unaffected.

HPR83 Unequal Access of Innovative Dermatology Products Across Canada

The objective of this analysis was to evaluate listing status across the public drug plans for the latest innovative dermatology products available on the Canadian market.

In Vitro and In Vivo Characteristics of Olive Oil as Excipient for Topical Administration.

Oily excipients are vital components of dermatological products. In this study, the in vitro and in vivo characteristics of Wild Olive Oil (WOO) were compared with two other types of olive oils: Extra Virgin Olive Oil (EVOO) and Virgin Olive Oil (VOO). This work has also included Liquid Paraffin (LP) and Rosehip Oil (RO) as reference oils. Melatonin was used in the study as a model drug to demonstrate the antioxidant capacity of the oils. The melatonin carrier capacity and antioxidant performance was related to the degree of unsaturation of the oils and was highest for RO and WOO and lowest for LP. However, the most stable oil to oxidation was LP. The in vivo performance of the oils in the skin of eight healthy volunteers was investigated with a dermoanalyser. The highest increment of oil and hydration in the skin was obtained with RO. The lowest perception of oiliness was described for WOO, which produced the highest increase in elasticity of the skin area where it was applied. An in vitro-in vivo correlation was therefore performed through multivariable analysis (MVA).

Multiparametric composite glow and radiance scale: an objective, scientific assessment tool for skin glow and radiance evaluation

<p class="abstract">There are numerous instruments available to assess pigmentation in terms of color, melanin, and other factors, but there is no standardized or validated tool to assess a person's glow and radiance. The MSCR- glow and radiance index (G&R)-composite scale was created with the help of a bio-physics background and includes five important factors. The scale is intended to provide an objective, scientific assessment tool for a highly subjective perception caused by numerous skin features. It should be emphasized that the scale is highly sensitive in measuring minor changes in the skin and generating numerical data that can be assessed using various statistical method. The numerical interpretation is also equivalent to measurements produced with a scientific instrument employing optometry principle, as evidenced by comparisons with other instruments. The assessment scale is an amalgamation of sensory visual evaluation with bio-physics that defines the optometric of the skin. The scale has been used to objectively assess skin glow and was found to be a highly sensitive assessment tool to assess all kind of dermatological products designed to provide enhanced glow and radiance.</p>

Dermal Delivery of Diclofenac Sodium-In Vitro and In Vivo Studies.

Previously, we reported the use of confocal Raman spectroscopy (CRS) as a novel non-invasive approach to determine drug disposition in the skin in vivo. Results obtained by CRS were found to correlate with data from the well-established in vitro permeation test (IVPT) model using human epidermis. However, these studies used simple vehicles comprising single solvents and binary or ternary solvent mixtures; to date, the utility of CRS for monitoring dermal absorption following application of complex marketed formulations has not been examined. In the present work, skin delivery of diclofenac sodium (DFNa) from two topical dermatological drug products, namely Diclac® Lipogel 10 mg/g and Primofenac® Emulsion gel 1%, was determined by IVPT and in vivo by both CRS and tape stripping (TS) methodologies under similar experimental conditions. The in vivo data were evaluated against the in vitro findings, and a direct comparison between CRS and TS was performed. Results from all methodologies showed that Diclac promoted significantly greater DFNa delivery to the skin (p < 0.05). The cumulative amounts of DFNa which permeated at 24 h in vitro for Diclac (86.5 ± 9.4 µg/cm2) were 3.6-fold greater than the corresponding amounts found for Primofenac (24.4 ± 2.7 µg/cm2). Additionally, total skin uptake of DFNa in vivo, estimated by the area under the depth profiles curves (AUC), or the signal intensity of the drug detected in the upper stratum corneum (SC) (4 µm) ranged from 3.5 to 3.6-fold greater for Diclac than for Primofenac. The shape of the distribution profiles and the depth of DFNa penetration to the SC estimated by CRS and TS were similar for the two methods. However, TS data indicated a 4.7-fold greater efficacy of Diclac relative to Primofenac, with corresponding total amounts of drug penetrated, 94.1 ± 22.6 µg and 20.2 ± 7.0 µg. The findings demonstrate that CRS is a methodology that is capable of distinguishing skin delivery of DFNa from different formulations. The results support the use of this approach for non-invasive evaluation of topical products in vivo. Future studies will examine additional formulations with more complex compositions and will use a wider range of drugs with different physicochemical properties. The non-invasive nature of CRS coupled with the ability to monitor drug permeation in real time offer significant advantages for testing and development of topical dermatological products.

A comprehensive comparison of facial skin hydration based on capacitance and conductance measurements in Chinese women.

The aim of this study was to compare the data of conductance and capacitance measurements of facial skin hydration and to evaluate and discuss the advantages and disadvantages of the different approaches. We measured skin capacitance (Corneometer® CM 825) and skin conductance (Skicon-200EX®) on 30 pre-defined facial sites of 125 Chinese women, resulting in 3750 readings per device. The data were analysed and compared, and continuous colour maps were generated on a 3D avatar for capacitance, conductance, relative difference (Δ%) and correlation (R-value) by interpolating between the individual readings and converting the values to colours. This visualization allows a better interpretation of the results. The complexity of facial skin hydration is revealed by this approach. The similarities and discrepancies in the facial hydration maps are clearly apparent. Due to the superiority of the Skicon in measuring high hydration levels, differences in skin hydration were evident on the forehead compared with the Corneometer maps, which may be related to the more superficial measurement of the Skicon within the stratum corneum. Conversely, a greater understanding of the complexity of facial skin hydration in the nasolabial fold was obvious when using the Corneometer. The best congruence between the instruments was found at two specific but separated facial areas, one around the inner eye region and the other one on a line between the nasolabial sulcus and the oblique, lateral jaw. Interestingly, the data were not normally distributed for both instruments and they had opposite skews. All facial clusters were statistically different from each other (p< 0.001), except the cheek and jaw for the Skicon. Larger than expected percentage coefficients of variance were found for the Corneometer on some facial sites that might be explainable by differences in stratum corneum physiology and biochemistry. Corneometer values of 48 AU and Skicon values of 132 μS were taken as the cutoff for normally hydrated facial skin. Both devices have their advantages and disadvantages suggesting that bio-instrumental measurement of skin hydration is actually more complicated than commonly thought and that the different facial zones and the use of multiple instrumentation have not been adequately considered.

Formulation and Evaluation of the In Vitro Performance of Topical Dermatological Products Containing Diclofenac Sodium.

The selection of an appropriate vehicle in a semi-solid topical product is of utmost importance since the vehicle composition and microstructure can potentially cause changes in drug–vehicle or vehicle–skin interactions and affect drug release and subsequent permeation into and across skin. Hence, the aim of this study was to evaluate different semi-solid formulations containing diclofenac sodium for the physicochemical and structural performance of excipients used and various physiological factors governing permeation of drugs applied to skin. The formulations (emulsion, emulgel, gel, and ointment) were prepared using conventional excipients and were found to be homogenous and stable. Rheological analysis demonstrated characteristic shear-thinning and viscoelastic behavior of formulations. The mean release rate of the gel formulation (380.42 ± 3.05 µg/cm2/h0.5) was statistically higher compared to all other formulations. In vitro permeation using human skin showed a significantly greater extent of drug permeation and retention for the emulgel formulation (23.61 ± 1.03 µg/cm2 and 47.95 ± 2.47 µg/cm2, respectively). The results demonstrated that the different formulations influenced product performance due to their inherent properties. The findings of this study demonstrated that a comprehensive physicochemical and structural evaluation is required to optimize the in vitro performance for dermatological formulations depending on the intended therapeutic effect.

Evaluating Poly(anhydride-ester) Encapsulation Characteristics for Delivery of Hydrophobic Small Molecules

Biodegradable salicylic acid-based poly(anhydride-ester)s (SAPAE) have proven to be effective in many biomedical applications including controlling inflammation, promoting bone growth, and preventing biofilm formation due to the release of salicylic acid upon hydrolysis of the polymer anhydride and ester bonds. Microspheres of SAPAE polymer are one fabrication option available for the encapsulation and controlled release of hydrophobic small molecules. This project aims to evaluate and characterize the ability for SAPAE microspheres to encapsulate, protect, and deliver retinol, a small hydrophobic molecule which is highly used in dermatological and cosmetic products for anti-aging purposes. The SAPAE of interest is a copolymer of salicylic acid (SA), adipic acid, and a diphenylene acetic acid (PAA). Due to supply chain limitations, the polymers used to form microspheres were of two variations, low molecular weight and high molecular weight. Nonetheless, this allowed for comparison of microspheres characteristics including size, morphology, and retinol loading efficiency. Through scanning electron microscopy (SEM), it was confirmed that the&nbsp;unloaded and retinol-loaded microspheres had a spherical shape, and the sizes were similar between the low molecular weight and high molecular weight polymer versions. Residual methylene chloride solvent was successfully reduced in all samples which increases the viability for biological applications. Finally, ultraviolet-visible spectroscopy detected a maximum of 4% w/v loading of retinol in the microspheres.&nbsp

Skin of Color Skin Care Needs: Results of a Multi-Center-Based Survey.

Targeted marketing and media may serve as potential sources of health information for consumers, influencing knowledge, practices, perception, and utilization of health care services. In addition to this vulnerable consumerism, there are barriers to healthy consumerism including exposure to different sources or lack thereof, lack of knowledge, inadequate transportation, or proximity to stores, cost, and marketing of products that are not suitable for all skin types. We conducted a multi-center &ldquo;Skin of Color Skin Care Needs&rdquo; survey to characterize the skin care practices, concerns, and habits of both persons of color and non-Hispanic whites to evaluate barriers and influences on product choice and behaviors in these populations. One hundred and twenty-one respondents (74%) self-identified as a nonwhite racial group, while 31 respondents (19%) self-identified as non-Hispanic white. The top skincare concerns in the skin of color population were acne and blemishes (40%), dry skin (32%), and pigmentation/dark spots (26%). In the non-Hispanic white population, the top concerns were fine lines and wrinkles (42%), followed by acne and blemishes (39%), and dry skin (26%). When questioned about barriers respondents faced in discovering and using dermatologic products, SOC respondents were more likely to cite lack of available products for their skin type (11%), as compared to white respondents (0%). Skin of color respondents identified internet (42%) and social media (29%) as major sources of information regarding dermatologic products as compared to white respondents (26% and 13%, respectively). Health care disparities can be heightened by targeted marketing and the media, which have a major impact on patient health literacy and consumer choices. Dermatologists should be aware of this impact in order to address the knowledge gaps, minimize bias, and increase inclusivity for all skin types. J Drugs Dermatol. 2022;21(7):709-711. doi:10.36849/JDD.6557.

The dose-duration effect on cutaneous pharmacokinetics of metronidazole from topical dermatological formulations in Yucatan mini-pigs

Dermal microdialysis (dMD) permits the investigation of cutaneous pharmacokinetics (cPK) for topical dermatological drug products (TDDP). dMD involves probe implantation into the dermis and a sample collection system that restricts subjects’ movements for the experimental duration. A truncated dose-duration, by TDDP removal at predetermined time-points, may help to adequately characterize the cPK in a relatively short time. The goals of this study were to: assess and compare the dose-duration effect on the dermal exposure of metronidazole (MTZ) containing TDDPs; and characterize MTZ dermal elimination following TDDP application and direct dermal delivery of MTZ utilizing a retrodialysis/microdialysis approach that we termed “dermal infusion.” MTZ cream and gel were applied on three Yucatan mini-pigs for dose-durations of 6-hr, 12-hr, or 48-hr. The gel’s dermal exposure was similar among the three dose-durations. Conversely, at the 6-hr dose-duration, the cream’s dermal exposure was significantly lower than other cream dose-durations while also comparable to the gel. In comparison, the 12-hr and 48-hr cream exposures were not significantly different. Terminal-phase half-live differences between the MTZ TDDP’s and dermal-infusion indicate flip/flop cPK. Truncating topical dose-duration may provide a valuable strategy to reduce experimental duration; however, dose-duration must be carefully selected if the goal is to discriminate between formulations.

Agro-biochemical Characterisation of Camelina sativa: A Review

Camelina sativa- an oil seed flowering plant that originated in North Europe and Central Asia is known by many names: gold-of-pleasure, false flax, wild flax and German sesame. Belongs to the Family Cruciferae, genus Camelina and it includes several species. Camelina has several favorable agronomic characteristics, it can be cultivated both in winter and spring season, having a remarkable capacity to adapt and resist to difficult climate conditions and pests. Camelina sativa contains 30-48% oil and 33-47% protein and adequate micronutrients with unique properties for industrial and nutritional applications. In addition, Camelina is a promising oilseed crop for production of edible oil, seed meal for animal feed rations and/or biodiesel feedstock. The high amounts of unsaturated fatty acids (about 90%) make camelina oil fast-drying which can be used for making polymers, varnishes, paints, cosmetics and dermatological products. Camelina sativa seed meal consisting of up to 50% crude protein- can be sold asan ingredient for cattle and chicken feed, adding further value to producing camelina. Overall, Camelina oil, due to its composition, has multiple uses in various industries: feed technology, biodiesel production, biopolymer industry, cosmetic industry (skin-conditioning agent), in food products due to its high omega-3 fatty acid content and low erucic acid content and as milk fat substitution.

The Use of Topical Antibiotics Based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data in 2017

The national action plan on antimicrobial resistance (AMR) in Japan emphasizes the importance of understanding antimicrobial use (AMU). Some studies have been conducted on oral and parenteral AMU in Japan. However, there are few studies on the use of topical antimicrobials, such as in dermatology and ophthalmology. Therefore, the purpose of this study was to investigate the use of topical AMU in Japan. Data on AMU in dermatology and ophthalmology were obtained from the 2017 National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. The number of dermatological products used was 58,396,530 in 2017. The proportions of betamethasone/gentamicin and gentamicin used were 50.5% and 16.7%, respectively, whereas that of the ingredient quantity in gentamicin was 7.8%. It has been suggested that topical AMU should be evaluated based on the number of products being used. The number of ophthalmological products used was 24,655,653 in 2017, and the proportion of quinolones used was 95.9%. The high prescription rate of quinolones may cause an increase in quinolone resistance in the ophthalmologic field. Topical AMU, which is a potential "blind spot" in the measures against AMR, needs to be continuously monitored, together with systemic AMU.

In vivo evaluation of topical ascorbic acid application on skin aging by 50MHz ultrasound.

Ascorbic acid (AA) is a powerful antioxidant capable of acting significantly both in the prevention and treatment of the skin aging process. One way to assess the in vivo efficacy of anti-aging treatments is by using the high-frequency ultrasound (HFUS) skin image analysis technique, a non-invasive approach that allows for a new level of evaluating the effectiveness of dermatological and cosmetic products. The aim of the present study was to assess the performance of a topical emulsion of liquid crystalline structures containing AA using the 50MHz HFUS skin image analysis method. Twenty-five healthy female participants between 35 and 60years were included, all of whom randomly applied a placebo formulation and an AA-containing formulation to each forearm, once a day, for 30days. HFUS measurements were performed before using the products (T0), 2h later (T2h), and after 30days of use (T30d). The analyzed parameters included total skin, dermal, and epidermal echogenicity; variation and mean thickness of total skin, the epidermis and dermis; and surface roughness. Statistical analyses were performed using the Friedman test, followed by Dunn's test for comparisons of multiple means (α=0.05). A significant increase in total skin and dermal echogenicity was observed after topical AA application. Our findings suggest that collagen synthesis significantly increased after topical therapy with AA, which was responsible for the increment in dermal echogenicity. This study showed, through the HFUS technique, that the topical use of AA promoted dermal redensification after 30days of application.

A Review on nano-emulsion based gel formulations: emulgel, technology and recent advances

Dermatological products are being used for treating skin infections and pain /inflammation related disease from ancient times. The topical drug delivery provides many advantages over the other routes of drug administration. Apart from conventional dosage forms like creams, powders, lotions, gels, ointments, researchers are exploring new modifications in the dosage form for improved drug penetrations and enhanced pharmacodynamic activity of poorly absorbed drugs from the skin. Existing topical formulations are associated with the problems like stability, stickiness, irritation, lower spreadability, limited drug permeability and absorption. Formulation of Nano-emulsion based gels (Emulgel) is proved to be prominent approach for overcoming the barriers associated with the conventional dosage forms. Emulgels are prepared by screening oils, surfactant and co-surfactant on the basis of drug solubility. Nano-Emulsion is prepared using suitable techniques and then embedded into the gel matrix for skin application. Drug present in the oil portion in the micelles form (less than 500nm globule size) provides more area for absorption thereby more penetration and therapeutic activity. Emulgel processes desirable properties like greaseless, spreadability, emollient, non-staining, good consistency and improved organoleptic characteristics. Permeations enhancers are also explored for enhancing the penetration of drug incorporated in the Emulgel.

Skin pharmacokinetics of diclofenac and co-delivered functional excipients

An important question in the development of a dermatological drug product is whether a target concentration has been achieved in, for example, the viable epidermis following topical administration. When attempting to address this challenge, it is essential to consider the role of excipients in the formulation that may influence drug partitioning and diffusion in the different layers of the skin. The objective, therefore, was to correlate, in human subjects, the skin pharmacokinetics of diclofenac (specifically, its uptake into and clearance from the stratum corneum (SC)) from an approved drug product (Voltaren® medicated plaster) with the in vivo co-uptake of two key excipients, namely propylene glycol and butylene glycol. SC sampling was used to assess diclofenac input into the skin during patch application, and its subsequent clearance post-removal of the delivery system. In parallel the uptake of the two glycol excipients was also measured. Drug and excipient amounts in the SC increased with time of application up to 6 h and, for diclofenac, no further increase was observed when the administration was prolonged to 12 h. When the plaster was removed after 6 h of wear, diclofenac cleared relatively slowly from the SC suggesting that drug binding with a slow off-rate had occurred. The results indicate that the optimisation of drug delivery from a topical formulation must take into account the disposition of key excipients and their impact on dermato-pharmacokinetics in general.

Knowledge and Treatment Behaviour of Acne Vulgaris among Female Students of University of Nigeria, Enugu Campus, Enugu State, Nigeria.

Acne Vulgaris is a common chronic inflammatory skin disease, with a prevalence of about 80% among adolescents and adults. The study was designed to assess knowledge and treatment behavior of acne vulgaris among female students of the University of Nigeria, Enugu campus, Nigeria. Descriptive survey design was adopted for this study. Three hundred and nineteen (319) female students of the University of Nigeria, Enugu Campus recruited through stratified random sampling were involved in the study. A questionnaire with a reliability coefficient of 0.80 Cronchbach alpha was used for data collection. Ethical clearance was obtained from the University of Nigeria, Teaching Hospital. Ethical principles of Informed consent, confidentiality and anonymity were maintained in the study. Data were presented in tables and analysed using descriptive statistics of frequency, percentages, means and standard deviation; and Chi-square (P < 0.05) inferential statistics. Majority (95.3% (304)) of the respondents have good knowledge of acne vulgaris. Consultation with a dermatologist was seen as very important for the management of acne vulgaris (M = 3.42 ± 0.62), removing acne by squeezing is not considered necessary (M = 2.04 ± 0.92) and the majority of the respondents (86.8%) use medically approved drugs and formulations like cleansers, exfoliants, sunscreen. No statistically significant relationship was found between the level of academic study and knowledge of acne vulgaris. Nurse educators must consolidate health campaigns on the evidence-based treatment options available for acne vulgaris. This is necessary to prevent complications arising from the use of untested dermatological products.

Prescribing Pattern of Dermatological Compounding in Ethiopia: The Case of ALERT Hospital.

BackgroundSkin diseases are among the major contributors of disease burden in Ethiopia affecting individuals of all age. Extemporaneous compounding of topical medications serves as a necessary option to treat skin diseases when manufactured medications could not meet specific patient needs. Different classes of drugs are commonly used for the treatment of dermatologic diseases. Failure to periodically assess the prescribing pattern and patient needs may lead to inappropriate planning and implementation that ultimately compromise the service. Periodic prescription analysis for compounded medications helps to monitor the prescription pattern with respect to medication selection, disease condition, dosage form types and other relevant parameters. The current study was conducted to analyze the pattern of compounding prescriptions for dermatologicals in ALERT hospital.MethodsA cross-sectional design was conducted by retrospectively evaluating compounding prescription records of January and July, 2021. A total of 460 prescriptions in the hospital community pharmacy were systematically selected. Data related to disease pattern, product selection and dosage form type were extracted and analyzed. Data analysis was done using software for the statistical package for social science version 25.0.ResultsA total of 441 prescriptions containing dermatological products for compounding were analyzed. Most patients were female (62.8%) and aged 30–64 years (44.0%). Psoriasis (36.2%), acne vulgaris (15.3%), and rosacea (13.4%) were the top 3 skin diseases for which the compounding preparations were prescribed. Salicylic acid (38.0%) was the most frequently prescribed drug followed by betamethasone (20.2%); while white petrolatum (47.2%) was the most common diluting agent used for compounding.ConclusionPsoriasis was the major dermatologic disease for compounding prescriptions and salicylic acid was the most frequent product used in compounding for treatment of the prescribed skin diseases.

The global impact of COVID-19 on drug purchases: A cross-sectional time series analysis

BackgroundThe drug supply chain is global and at risk of disruption and subsequent drug shortages, especially during unanticipated events. ObjectiveOur objective was to determine the impact of coronavirus disease 2019 (COVID-19) on drug purchases overall, by class, and for specific countries. MethodsA cross-sectional time series analysis of country-level drug purchase data from August 2014 to August 2020 from IQVIA MIDAS was conducted. Standardized units per 100 population and percentage increase in units purchased were assessed from 68 countries and jurisdictions in March 2020 (when the World Health Organization declared COVID-19 a pandemic). Analyses were compared by United Nations development status and drug class. Autoregressive integrated moving average models tested the significance of changes in purchasing trends. ResultsBefore COVID-19, standardized medication units per 100 population ranged from 3990 to 4760 monthly. In March 2020, there was a global 15% increase in units of drugs purchased to 5309.3 units per 100 population compared with the previous year; the increase was greater in developed countries (18.5%; P < 0.001) than in developing countries (12.8%; P < 0.0001). After the increase in March 2020, there was a correction in the global purchase rate decreasing by 4.7% (April to August 2020 rate, 21,334.6/100 population; P < 0.001). Globally, we observed high purchasing rates and large changes for respiratory medicines such as inhalers and systemic adrenergic drugs (March 2020 rate, 892.7/100 population; change from 2019, 28.5%; P < 0.001). Purchases for topical dermatologic products also increased substantially (42.2%), although at lower absolute rates (610.0/100 population in March 2020; P < 0.0001). Interestingly, purchases for systemic anti-infective agents (including antiviral drugs) increased in developing countries (11.3%; P < 0.001), but decreased in developed countries (1.0%; P = 0.06). ConclusionWe observed evidence of global drug stockpiling in the early months of the COVID-19 pandemic, especially among developed countries. Actions toward equitable distribution of medicines through a resilient drug supply chain should be taken to increase global response to future unanticipated events, such as pandemics.