By Jerry and Lisa Meloche, Pharm.D., Owners, Compounding Pharmacists
August marks Psoriasis Awareness Month, an important time to spotlight this chronic, immune-mediated skin condition that affects more than 8 million people in the U.S. and 125 million worldwide. Psoriasis is more than a skin issue—it’s a systemic inflammatory disease that often impacts quality of life, emotional well-being, and overall health. While conventional therapies offer relief for some, others find limited benefit or experience unwanted side effects. For these patients, compounded medications like low-dose naltrexone (LDN) and topical vitamin B12 offer promising complementary approaches.
Understanding Psoriasis
Psoriasis is an autoimmune disease characterized by the rapid overproduction of skin cells, leading to thickened, red, scaly patches on the skin. The most common type, plaque psoriasis, is driven by dysregulated T-cell activity and pro-inflammatory cytokines like TNF-alpha, IL-17, and IL-23. This chronic inflammation is also linked to an increased risk for comorbidities such as cardiovascular disease, obesity, depression, and psoriatic arthritis.
First-line treatments typically include:
• Topical corticosteroids
• Vitamin D analogs (e.g., calcipotriol)
• Phototherapy
• Biologic injections targeting specific cytokines
However, these therapies may be costly, lose effectiveness over time, or come with risks such as immunosuppression or skin thinning. This is where compounded alternatives may offer targeted, safer, and more customizable support.
What Is Low-Dose Naltrexone (LDN)?
Naltrexone is an FDA-approved medication originally used at higher doses (50–100 mg/day) to treat opioid and alcohol dependence. In much lower doses (0.5–4.5 mg/day), it exerts immunomodulatory and anti-inflammatory effects, making it an increasingly popular off-label option for autoimmune and inflammatory conditions—including psoriasis.
How LDN Works in Psoriasis
At low doses, naltrexone:
• Temporarily blocks opioid receptors, triggering a rebound increase in endorphin and enkephalin production.
• These endogenous opioids then bind to immune cells, modulating T-cell function and reducing pro-inflammatory cytokines like TNF-alpha and IL-6.
• LDN also downregulates microglial activation in the central nervous system, helping reduce systemic inflammation.
A small but growing body of research and clinical experience supports the use of LDN for skin conditions. A 2020 case study published in Dermatologic Therapy described a patient with recalcitrant psoriasis who achieved marked improvement after initiating LDN, suggesting it may be a viable adjunct or alternative to biologics.
Because it is not commercially available in these low doses, LDN must be compounded by a licensed pharmacy like Creative Scripts, ensuring precise dosing, quality control, and patient-specific customization (capsules, suspensions, or topical formats).
The Role of Topical Vitamin B12 in Psoriasis
Vitamin B12, or cobalamin, is essential for cellular repair, DNA synthesis, and immune system regulation. In recent years, topical vitamin B12 formulations have gained interest for inflammatory skin conditions, particularly eczema and psoriasis.
How Topical B12 Supports Psoriatic Skin
• Vitamin B12 acts as a nitric oxide scavenger, which is relevant since excess nitric oxide contributes to keratinocyte hyperproliferation and inflammatory signaling in psoriatic lesions.
• It may inhibit cytokine release and improve mitochondrial function in skin cells, aiding in normalization of skin turnover.
• In a randomized, controlled trial published in the British Journal of Dermatology, patients applying a vitamin B12 cream twice daily saw significant improvement in plaque psoriasis after 12 weeks, with no reported adverse effects.
Compounding pharmacies can formulate topical B12 creams in non-irritating bases, without steroids or preservatives, ideal for long-term use on sensitive or resistant areas (like the face or genitals).
The Value of Compounded Therapies for Psoriasis
Psoriasis is a complex, variable condition, and no single treatment works for everyone. This is where compounding pharmacies play a pivotal role—
especially for patients who are:
• Non-responsive or intolerant to standard treatments
• Seeking integrative or steroid-free options
• Interested in adjunct therapies to reduce dependence on biologics
At Creative Scripts Compounding Pharmacy, custom formulations like oral LDN or topical vitamin B12 can be created to suit each patient’s unique medical history, body site involvement, and treatment goals.
Additional compounded formulations that may benefit psoriatic patients include:
• Topical salicylic acid + coal tar
• Topical D3 analogs with moisturizers
• N-acetylcysteine (NAC) in cream form, another antioxidant with anti-inflammatory benefits
• Medications compounded into hypoallergenic, non-comedogenic bases
Pharmacists at Creative Scripts collaborate closely with prescribing providers to ensure safe dosing, titration plans, and appropriate monitoring.
Creative Scripts Compounding Pharmacy custom builds medication, one patient at a time. We use the highest quality pharmaceutical-grade ingredients, state-of-the-art bases, equipment, and technology. Ongoing training on the latest techniques, advances in therapy, and regulations enables our pharmacists and technicians to provide the safest, most effective medications for you and your pets. In addition to compounded medications, we offer pharmaceutical-grade nutritional supplements, health advice, and hormone consultations. Creative Scripts specializes in veterinary compounding, dermatology, bio-identical hormone replacement therapy (BHRT), pain management, and more. Pharmacists Jerry and Lisa Meloche have served Naples and surrounding communities since 2005.
239-261-0050
600 Goodlette Road North #108
Naples, FL 34102
www.creativescripts.net