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Master formulation in dermatology: when is it indicated?

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Know when the magisterial formulation is indicated in dermatology (creams and lotions prepared in pharmacy), as well as its advantages and disadvantages.

Sometimes dermatologists prescribe a prescription where we write a formula to treat his pathology. And why do we do it? Is a cream formula prescribed by a dermatologist the same as a commercial cream? Can a pharmacy prepare a cream well? In the following text I answer these and other questions on this topic.

Why does my dermatologist prescribe a lotion or cream for me to make at the pharmacy?

The magistral formula has been classically used in dermatology and even today, with the large number of treatment creams and cosmetic products marketed, it continues to occupy a place in skin therapy. We usually prescribe a master formulation when we do not find or know a cream on the market that meets the needs treatment that we want to prescribe for a patient's dermatological condition at a given time. And not only do we prescribe creams, but also the magisterial formulation includes tablets (oral treatment).

We can summarize it in the following Table, adapted from Sánchez-Regaña et al.:

  • No such drug or cream is marketed (not manufactured, out of stock, withdrawn from the market, etc.).
  • This formula facilitates the administration and compliance of the treatment by the patient.
  • The formula allows to eliminate excipients or compounds that cause allergies.
  • The formula allows the active ingredients to be graduated and adapted to the patient.
  • The formula increases the effectiveness of the treatment.

Are master formulas or personalized creams widely used?

Dermatology is possibly the medical specialty in which they are used the most, since the variability of active principles, vehicles and their way of optimizing each patient is extensive. Traditionally, compounding has been associated with ancient medicine, and in countries like Germany it represents approximately 4% of medical prescriptions worldwide. In the case of dermatology, this percentage is possibly higher.

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What does a recipe for a master formula look like?

It is a recipe in which dermatologists will prescribe one or more active ingredients, the percentage of each one of them, the base or the vehicle where they will be included and the necessary amount.

How is a formula made in the pharmacy different from a commercial cream?

It differs above all in that in them I find what I want or what I consider best to treat the patient at that time and that I do not find it commercialized. Personalized creams allow me to solve circumstances in treatments that I could not solve with the creams on the market.

Do all pharmacies prepare creams?

Not all pharmacies have a laboratory and formulating pharmacist who prepares creams. However, all of them have the capacity to dispense master formulas to the patients who come to them, so if they do not have the capacity to make creams, they ask another pharmacy to prepare them.

What are the disadvantages of using a composition formula?

• One of the disadvantages of using personalized pharmacy creams is that the vehicles, textures and perfumes are not as pleasant as industrial creams.

• The elaboration is not homogeneous, there may be some error and also variability in the elaboration of the different bases between pharmacies.

• The formulations contain less information, with a label and not with a prospectus.

• There may be price variations from one pharmacy to another.

References to prepare this article on compounding in dermatology

1. Sánchez-Regaña M, Llambí-Mateos F, Salleras-Redonnet M, Iglesias Sancho M, Collgros Totosaus H, Umbert-Millet P. Compounding as a current therapeutic option in dermatology. Actas Dermosifiliogr. 2013; 104: 738-56. PMID: 22818830.

2. Abarca Lachén E, Hernando Martínez P, Gilaberte Calzada Y. The most useful pharmaceutical formulations (individualized drugs) in pediatric dermatology: a review. Actas Dermosifiliogr. November 18, 2020: S0001-7310 (20) 30477-4. PMID: 33220314.