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CONTINUING PROFESSIONAL DEVELOPMENT
SOLUTIONS THROUGH COMPOUNDING
for topical application
BY DR ALISON HAYWOOD MPS & PROFESSOR BEVERLEY GLASS MPS
Topical corticosteroids are important in the management of
dermatological conditions because of their anti-inflammatory and
Hydrocortisone, classified according to
the Australian Medicines Handbook2 and
Therapeutic Guidelines: Dermatology3
as a mild topical corticosteroid, is
available in Australia (most commonly
as hydrocortisone acetate) as an
ointment (1%), cream (0.5% and 1%)
and spray (1%). A rectal foam (10%
w/w) is available for the treatment of
inflammatory rectal conditions (e.g.
ulcerative colitis, proctosigmoiditis and
Ointments, due to their occlusive
nature, are more potent than creams
for a given strength of corticosteroid.
such as propylene glycol, included in
skin formulations will also increase
relative potency, due to their ability
to enhance the skin penetration of
the corticosteroid.2 Creams can be
used on moist skin such as weeping
lesions, while ointments are particularly
effective for dry and scaly skin.
are generally easier to apply to larger
areas of the body, thinner in consistency,
and are more convenient for application
to hairy areas and where skin rubbing
occurs (such as between thighs and
underarms), due to their lubricant
effect.5 Corticosteroids, formulated
as lotions, are also appropriate for
application to the scalp.
Lotions are liquid or semi-liquid
preparations that may contain aqueous,
ethanolic or emulsified vehicles.
emulsified vehicles are thickened by
the oily phase, aqueous and ethanolic
vehicles usually include a gelling agent
as a thickener. Gels are transparent or
translucent semi-solid preparations that
consist of a liquid phase suspended
within a three-dimensional polymer
Common gelling agents include
tragacanth, alginates, methylcellulose,
carbomer and polyvinyl alcohol.
may however also include an oily phase
(organogels)6 allowing for the inclusion
of water insoluble active pharmaceutical
ingredients (API) in the oily phase,
without requiring cosolvents such as
propylene glycol or alcohol.
Table 1 lists examples of hydrocortisone
lotions that are commercially available
outside of Australia, including their
Hydrocortisone may be compounded
for topical application when there
is disruption of supply, due to the
occurrence of excipient-related
the requirement for non-standard
concentrations of hydrocortisone and
the lack of availability of a particular
dosage form – such as a lotion or gel in
, MW 362.5)
is a white or almost white, crystalline
powder that is practically insoluble
in water and sparingly soluble in
alcohol and in acetone. It undergoes
polymorphism and should be protected
Hydrocortisone acetate (C23H32O6,
MW 404.5), is a white to practically
white, odourless, crystalline powder
that is insoluble in water and slightly
soluble in alcohol, and should be stored
protected from light.
Dr Alison Haywood, Senior Lecturer, School of
Pharmacy, Griffith University, Gold Coast Campus.
Professor Beverley Glass, Pharmacy, College of
Medicine and Dentistry, James Cook University,
After reading this article, pharmacists should be
Recognise when compounding hydrocortisone
preparations to meet specific patient
requirements is necessary, and the precautions to
be taken by pharmacists in undertaking this task
Explain how to prepare a topical hydrocortisone
gel extemporaneously, including the
components, methods of preparation, packaging,
and storage and labelling
Counsel patients/carers on the appropriate use of
and the precautions to be taken when using this
Competencies addressed: 1.1 .1, 1.1 .2, 4.2 .3, 4.3 .3,
5.1.2, 5.1.3, 5.1.4, 5.1.6, 5.2.1.
Accreditation number: CAP160808E
Degradation of hydrocortisone may
occur by two pathways – at the carbon
17 (C-17) side chain (pathway A) and
at ring A (pathway B) (see Figure 1).
The vehicle for hydrocortisone has been
reported to influence its stability, with
instability in water and polyethylene
glycol base reported.
water (at 65 °C) degradation occurred
by both pathways, the addition of
alcohol and glycerol had a stabilising
16 Degradation via pathway B
predominated in the polyethylene
glycol base and was accelerated at
higher temperatures, probably due
to a phase change from a semisolid at
room temperature to a liquid at 65 °C.
However hydrocortisone compounded
in a VersaPro cream base retained >95%
of API content at room temperature
despite the proprietary vehicle having a
water content of >75%.
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