Our website uses cookies to improve and personalize your experience. We do not sell your information. Our website may also include cookies from third parties like Microsoft Clarity, Google Analytics, Google Adsense. By using the website, you consent to the use of cookies. We have updated our Privacy Policy. Please click on the button to check our Privacy Policy.

Do you Need a Compounding Pharmacy for Lichen Sclerosus?

Do you Need a Compounding Pharmacy for Lichen Sclerosus?

Introduction

Today, we will address a question we frequently get via email and at LSSN’s virtual meetups. That is, do you need a compounding pharmacy for lichen sclerosus? Some of you may already be familiar with compounding pharmacies and the concept of compounding medications. Others may be hearing this for the first time. Either way, this conversation usually spikes a lot of intrigue and curiosity about whether or not you need one.

In this post, we will address:

  • What is a compounding pharmacy
  • What kind of medications are offered at compounding pharmacies
  • Benefits of compounding pharmacies
  • Cons of compounding pharmacies
  • Do you need a compounding pharmacy for lichen sclerosus
  • When should you consider a compounding pharmacy for lichen sclerosus and,
  • Important notes about compounding medications

Disclaimers

*If this post is helpful to you, we’d love your support so we can continue providing important education like this. Make a donation today, volunteer with us, and/or share our posts in your support groups.

**The information contained in this blog post is up-to-date at the time of publication. 

What is a Compounding Pharmacy

A compounding pharmacy is a pharmacy that specializes in creating custom-made medications. Specifically, compounding medications involves mixing, combining, and changing ingredients to create the final product.

Graphic image design of a pharmacist holding up a prescription that they compounded at their compounding pharmacy.

Let’s compare this to a traditional or retail pharmacy, which is more popular–think CVS or Walgreens if you’re in the States or Shopper’s Drug Mart if you are in Canada. Retail pharmacies sell medicines that manufacturers make. 

For example, consider Clobetasol ointment, which is a popular treatment for lichen sclerosus in North America. My Clobetasol is manufactured by a company called Taro Pharmaceuticals. This means that my Clobetasol can be found in thousands of retail pharmacies across Canada, where I live. Further, the Clobetasol offered in retail pharmacies will have the exact same dosage of medication (the steroid), and the base ingredients–propylene glycol, sorbitan sesquioleate, and white petrolatum–will all be identical. If my friend in Québec picks up her Clobetasol at Pharmaprix (a retail pharmacy) and I pick mine up at Shopper’s Drug Mart in Ontario (another retail pharmacy), we will have the exact same medication.

Conversely, compounding pharmacies can make specialized medication custom to your unique needs. For example–and we’ll dive deeper into this shorter–if you have an allergy to an ingredient in a medication that is typically mass-produced, you may need to have your medication custom-made without the allergen in question. Compounding pharmacies can adjust the dose of the medication as well as alter the base (if the medication is a cream, gel, lotion, or ointment).

What Kinds of Medications Are Offered at Compounding Pharmacies?

There are two types of medications that are made at compounding pharmacies. Firstly, there are sterile compounds. Sterile compounds are medications injected into your tissue/blood or the eyes (think eye drops). Secondly, non-sterile compounds are made at compounding pharmacies. These are things like capsules, creams, and ointments. 

The most common types of compounded medications are drugs for pain management (e.g., gabapentin, baclofen, ketamine, lidocaine, etc.) as well as hormone replacement therapies (e.g., progesterone, estradiol, testosterone, etc.) (McPherson et al., 2016). Further, compounding medications are commonly used in dermatology to help increase the therapeutic effects of the medication (Todorova et al., 2016)

Graphic image design of a prescription pad, jars of medicated creams and ointments and a pill bottle with some pills on the side representing different medications compounding pharmacies can create.

In the context of vulvar lichen sclerosus, we are looking at non-sterile compounds, as there are currently no injectable at-home treatment options for lichen sclerosus. Learn more about LS treatments here.

Compounding pharmacies use pure, pharmaceutical-grade ingredients when creating medications. These ingredients must be made at a facility that is registered with the FDA or the country’s regulatory health agency.

Benefits of Compounding Pharmacies

Benefits include,

  • Customized, flexible, and precise dosing of medications and ingredients when a commercially available product is unavailable (e.g., on backorder) or appropriate for the patient (Gudeman et al., 2013).
  • Allows people with allergies to get their treatment without their allergens included in the medication (Lisi, 2021).
  • If you have specific preparation requests (e.g., wanting medication to be casein-free, vegan, Kosher, etc.) (Bell, 2012).

Cons of Compounding Pharmacies

Cons of using compounding pharmacies/compounded medications include,

  • Compounded medications tend to be more expensive than traditional, commercially-produced medications (Gudeman et al., 2013).
    • Where you live in the world and how insurance works in your country can impact cost. In Canada, where I (Jaclyn) live, all the compounded medication I’ve ever used (mostly for trigeminal neuralgia and pain) was quite expensive, and my insurance did not cover it.
    • If you are concerned about cost, call the compounding pharmacy ahead of time to ask for a cost estimate, and call your insurance to see if they cover some of the cost.
  • Compounded medications tend to have a shorter shelf life and expire much quicker than traditional, commercially-produced medications. 
  • The FDA does not typically inspect compounding pharmacies nor evaluate the quality of the compounded medications (National Academies of Sciences).
  • Illness and side effects have been documented in some cases with poor-quality compounding (U.S Food and Drug Administration, 2021).

Do you Need a Compounding Pharmacy for Lichen Sclerosus?

Image of a person with dark brown skin, a blue sweater, and black hair up in a bun, with a chat bubble that reads: "Do I need a compounding pharmacy for lichen sclerosus"?

For the most part, you do not need a compounding pharmacy for lichen scleorsus. Many people are perfectly OK using commercially produced medications filled at traditional retail pharmacies.

When Do You Need a Compounding Pharmacy for Lichen Sclerosus?

However, there are instances when it may be important or necessary to switch to a compounding pharmacy, such as:

  • You have an allergy to an ingredient in the base of your medication, such as propylene glycol.
  • You are sensitive to an ingredient in the base of your medication, such as parabens.
  • Recurrent yeast infections may call for your steroid to be compounded together with an anti-fungal.
Graphic image design of of an allergy alert card.

If you suspect you are having a reaction to any component of your medication, it’s important to discuss this with your healthcare provider. First, they may try to change your medication to see if you have a better response to the switch. Some folks with paraben sensitivities have a hard time on Clobetasol but do well with a switch to Mometasone, which is formulated without parabens. 

If your doctor suspects an allergy, they may send you to an allergist for testing. Once the results are in and the allergens have been identified, your doctor can work with a compounding pharmacy to develop a formula that doesn’t contain the allergen(s) in question. For example, if you are allergic to propylene glycol, your compounding pharmacist may create a custom steroid ointment without propylene glycol.

Other Times A Compounding Pharmacy May Be Necessary for Lichen Sclerosus

For many people, either topical corticosteroids or topical calcineurin inhibitors will be the primary treatment for LS.

However, there are cases where other medications are prescribed as adjuncts to your main primary treatment. For the difference between treatments and adjunct therapies, click here. For example, your doctor may prescribe a topical pain cream or ointment if chronic pain is part of your LS experience. They may compound gabapentin with baclofen, for example, if they suspect your pain is due to overactive nerves. If you are experiencing genitourinary syndrome of menopause, you may have topical estrogen as part of your care plan, and some people need their hormone creams compounded. For example, Dr. Krapf and Dr. Goldstein sometimes prescribe a compounded combination of testosterone and estrogen to help improve the elasticity and moisture of the vulvar skin (Goldstein, Pukall, Goldstein, and Krapf, 2023). 

Important Notes about Compounded Medications 

These medications tend to expire quicker than traditional, commercially-produced ones, so be sure to adhere to the expiration date on your medication. Click here to learn more about expiration dates and LS medications.

Compounded medications can be more expensive. Call your compounded pharmacy and ask for a quote first, and then call your insurance to see if they can cover some of the cost.

Conclusion on Compounding Pharmacies for LS

In sum, many people are perfectly OK to use a retail pharmacy for their LS medications. However, if you have a sensitivity/allergy to a medication or ingredient in the base of the medication, you may need your medication custom-made at a compounding pharmacy. If you experience recurrent yeast infections with LS, some doctors may prescribe a compound that combines your steroid with an anti-fungal medication. Finally, some adjunct treatments like estrogen may require compounding. Compounded medications are often more expensive than regular, commercially-produced medications, depending on where you live. Be sure to adhere to the expiry date of your compounded medications, if you have any, as they do not last as long as regular, commercially-produced medications.

Stay in the Loop! Never Miss a Blog Post, YouTube Video, Podcast Episode, Event, or Product Launch by Getting on Our Newsletter!

Sign up for LSSN’s monthly newsletter here.

Sign up for TLLC’s newsletter here.

Reach Out to Me

Whether you are debating booking a support call with me, have a quick question, or want to share something related to my content, I can be reached via:

Email: Jaclyn@lostlabia.com

DM: @thelostlabiachronicles on Instagram, Facebook, and TikTok.

Support Resources

FREE Lichen Sclerosus Virtual Meetup hosted by myself and Kathy of Lichen Sclerosus Podcast – sign up here.

Feel free to book a 1:1 call with me if you struggle with grief and emotions. Simply click this link to learn more about lichen sclerosus peer support calls.

Image of a person with dark brown skin and dark hair wearing a yellow shirt sitting at a desk on a call. The title text reads, "1:1 LS Peer Support Calls, book now".

LSSN Membership – sign up here.

For a more detailed list of free and paid support resources, check out my LS resources page here.

References

1.Jersey DML PharmD, BCPS, BCGP, BCPP, BCACP Hackensack Meridian Health Eatontown, New. Pros and Cons of Pharmacy Compounding. www.uspharmacist.com.

2.Gudeman J, Jozwiakowski M, Chollet J, Randell M. Potential Risks of Pharmacy Compounding. Drugs in R&D. 2013;13(1):1-8.

3.Bell E. The benefits and risks of compounding pharmacies. www.healio.com.

4.McPherson T, Fontane P, Iyengar R, Henderson R. Utilization and Costs of Compounded Medications for Commercially Insured Patients, 2012-2013. Journal of Managed Care & Specialty Pharmacy. 2016;22(2):172-181.

5.Anna Todorova, Viliana Gugleva, Georgieva L. Doctors’ point of view on Pharmacy Compounding – Advantages and disadvantages. International Archives of Integrated Medicine. 2016;3(2).

6.National Academies of Sciences E, Division H and M, Policy B on HS, Creams C on the A of the ASDR the S and E of IU in CTP, Jackson LM, Schwinn DA. Gaps in Regulation, Oversight, and Surveillance. www.ncbi.nlm.nih.gov. Published May 13, 2020. Accessed November 11, 2023.

7.Research C for DE and. Compounding Risk Alerts. FDA. Published online October 6, 2023. Accessed November 11, 2023.

8.Goldstein A, Pukall C, Goldstein I, Dr. Jill Krapf. When Sex Hurts. Hachette Go; 2023.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Related Posts