Next generation personalized anti-aging medicine; an evolving era of pharmaceutical compounding

By Dr. Ellie Rahmani, PharmD, PhD, RPh

Personalized anti-aging medicine is transforming the skincare landscape with pharmaceutical compounding at its core. This forward-thinking approach acknowledges that skin aging is not uniform; it varies greatly from person to person. By tailoring treatments to target individual concerns—such as fine lines, hyperpigmentation and dryness—this paradigm shift enables precision in addressing the unique challenges of aging skin.

This evolving approach combines the expertise of dermatologists and compounding pharmacists to formulate unique solutions that cater to each patient’s skin type, sensitivity, and specific aging challenges.

By combining innovative active ingredients with advanced targeted drug delivery technologies, compounded formulations offer tailored therapies that are reshaping the anti-aging landscape. This shift from generic skincare to a patient-centric approach enhances both treatment outcomes and patient satisfaction. The success of these therapies relies on the careful selection of active ingredients and the optimization of their delivery systems to ensure maximum efficacy.

The skin consists of three primary layers:

• Epidermis: Serves as the outermost protective barrier and contains keratinocytes, melanocytes (responsible for pigmentation), and Langerhans cells, playing a vital role in skin regeneration and protection against environmental factors like UV radiation.
• Dermis: The middle layer, rich in collagen and elastin, which provides strength and elasticity while supporting blood vessels, hair follicles, and nerve endings.
• Hypodermis: The subcutaneous layer, made of fat and connective tissue, that offers insulation and energy storage.

Skin aging is influenced by intrinsic factors like genetics and hormonal changes, as well as extrinsic factors such as sun exposure and pollutants. This process results in fine lines, wrinkles, and uneven skin tone, especially in areas exposed to sunlight.

A significant intrinsic factor contributing to skin aging is menopause, which causes a substantial decline in estrogen levels. Estrogen is essential for maintaining skin thickness, hydration, and overall health. As estrogen levels drop during menopause, women may experience faster skin thinning, reduced collagen production, and a weakened skin barrier, leading to dryness, itching, fine lines, and a general decline in skin texture.

Topical estrogens and phytoestrogens have shown promise in mitigating these skin changes. Phytoestrogens, such as genistein, mimic estrogen's effects and are gaining attention for their anti-aging properties. Compounding pharmacists can create tailored formulations with these compounds to enhance hydration and elasticity in postmenopausal women. Given that estrogens are highly lipophilic molecules, an effective dermal delivery base is essential to enhance their delivery to the appropriate skin layers. Targeted nano structured lipid carriers, which transport highly lipophilic molecules without using permeation enhancers such as propylene glycol or occlusive waxes such as silicone, offer effective and healthy solutions with reduced risk of itchy skin and systemic side effects.    

It is important to consider that some post-menopausal women may experience acne; therefore, opting for less oily formulations that still offer moisturizing and enhanced dermal delivery properties can be beneficial.

Fine lines and wrinkles are caused by decreased collagen and elastin production, two proteins crucial for maintaining the skin's structure, tonicity and elasticity. Anti-aging strategies aim to reverse both photoaging and chronological aging by targeting molecular pathways.

Compounding pharmacies offer a variety of topical agents with anti-aging properties, broadly divided into two categories:

• Antioxidants: Ingredients like vitamins C, E, and B3, which neutralize free radicals and prevent collagen degradation.
• Cell Regulators: Compounds such as retinoids, peptides, and growth factors, which stimulate collagen production and inhibit its breakdown by blocking matrix metalloproteinases (MMPs).

The delivery system is just as important as the active ingredient itself, as it must accommodate both the molecular structure of the ingredient and the patient’s specific needs.

For instance, Vitamin C (L-ascorbic acid) is renowned for its collagen-boosting and antioxidant properties, but its sensitivity to light and heat makes it difficult to formulate. Nano-encapsulation technologies offer advanced solutions by protecting ingredients like Vitamin C, ensuring their stable delivery to the dermis in an active form.

Retinoids, while effective in stimulating collagen production, can cause irritation, particularly in sensitive individuals. Nano-encapsulation can enhance their stability and minimize irritation, increasing their suitability for a wider range of patients. Additionally, using delivery bases with skin-repair properties can further reduce irritation and improve patient outcomes.

Recent advancements in nano structured lipid carriers have revolutionized the targeted delivery of anti-aging peptides to the dermis. These innovations improve the stability and bioavailability of peptides, allowing compounding pharmacists to create customized take-home kits for patients recovering from procedures like microneedling. This not only enhances treatment outcomes but also provides accessible solutions for long-term skin maintenance.

In personalized anti-aging medicine, Platelet-Rich Plasma (PRP) and exosome therapies are gaining traction. PRP, rich in growth factors, promotes skin healing and rejuvenation. Exosomes, which facilitate intercellular communication, enhance tissue repair. Combined, these therapies offer powerful anti-aging effects, but their delivery presents challenges due to the high molecular weight of their protein components. Nano-lipid carriers can encapsulate these biologics, enhancing their skin penetration.

As the skin ages, the epidermis thins, though the number of cell layers remains constant. Hyperpigmented lesions, commonly known as "age spots" or "liver spots," frequently appear in sun-exposed areas.

The first-line treatment for hyperpigmentation typically involves topical depigmenting agents combined with photoprotection, such as sunscreen. Topical tyrosinase inhibitors — including hydroquinone, azelaic acid, kojic acid, arbutin, and certain licorice extracts — are particularly effective in lightening hyperpigmented areas.

Other agents, such as retinoids, ascorbic acid, niacinamide, and cannabidiol oil, also show promise, with innovative nano-lipid-based therapies emerging on the horizon.

Caution must be exercised to prevent skin irritation with these treatments. When compounding skin-lightening APIs, it is crucial to select topical bases suited to the patient’s skin type and sensitivity. Gel bases or light oil-in-water lotions are ideal for acne-prone skin, while cream bases are better suited for dry skin. Choosing bases with skin-repairing properties can help mitigate irritation from active ingredients. Additionally, when prescribing retinoids, it is essential to rule out pregnancy, as retinoids pose a significant risk of birth defects if used during pregnancy.

Personalized anti-aging medicine, fueled by advanced nano drug delivery technologies, signifies a major advancement in skincare. By addressing the unique needs of individual patients and leveraging the distinct molecular properties of active ingredients along with appropriate delivery systems, compounding pharmacists can create tailored therapies that redefine the anti-aging landscape. As the field continues to evolve, we can anticipate improved treatment outcomes and increased patient satisfaction through innovative, personalized skincare solutions, including the promising integration of peptide and exosome therapies, as well as targeted nano-lipid drug delivery technologies.

Dr. Ellie Rahmani, PharmD, PhD, is a nano drug delivery scientist and entrepreneur who brings over two decades of executive leadership in health care. She pioneers sustainable pharmaceutical research, manufacturing, and product development.