Topical cream formulation

The stratum corneum is typically 10–20 μm thick and consists of extracellular lipid-surrounded corneocytes. The lipophilic environment of the stratum corneum can serve as a reservoir for certain highly lipophilic molecules. Keratin found in the stratum corneum may provide great affinity with certain drugs. Both of these interactions can play a role in drug accumulation in the stratum corneum and the local drug action on skin disease.[4]

Below the stratum corneum is the viable epidermis. The viable epidermis is usually 50–100 μm thick. It includes immunologically sensitive cells (e.g. Langerhans cells), and metabolically active cells (e.g. keratinocytes, melanocytes, merkel cells). Melanocytes are involved in melanoma pathogenesis. As a result, drugs treating melanoma need to be administered to the lower epidermis.

The dermis lies next to the epidermis. It is a 1–2 mm layer mainly composed of fibroblasts and immune cells (e.g. dermal dendritic cells, macrophages, T cells, mast cells) in a collagen and elastic fiber extracellular matrix.[5] These immune cells play important roles in parasitic infections, psoriasis induction, tumor progression, dermal inflammation, angiogenesis, wound healing, tissue remodeling, skin sensitization, and tolerance.[10] Therefore, the regional accumulation of drugs in the dermis is necessary for the prevention and treatment of these local skin diseases.

The hair follicle is an invagination of epidermis cells deep into the dermis. The follicular route is critical in the topical delivery of particle-based formulations and hydrophilic, high-molecular-weight drugs. The follicular route provides benefits such as deeper penetration, prolonged residence duration, faster entry into the skin, and site-specific targeting.[11]

Beneath these layers lies the hypodermis, which is composed of adipose tissue, fascia, as well as larger lymphatic and blood vessels. For joint and muscle disease treatment, topically applied drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) can penetrate the subcutaneous tissue or even deeper tissues in the hypodermis.[12] Drugs are primarily delivered into the underlying muscle by direct penetration without prior entry into the systemic circulation to prevent unintended side effects.

In general, there are three possible routes for drug administration into or across the skin. The first one is the transcellular route, where the drugs are required to pass through both lipid matrix and dead corneocytes of the stratum corneum. The second one is the intercellular route, where the drugs only have to pass through lipid domains between corneocytes. The third one is the trans-appendageal route, where the drugs are transported by hair follicles, sebaceous glands, or sweat glands.[4]

The most common route for drug delivery into the skin is the intercellular route. Multiple steps are involved.[13]

1. Dissolution and release from the formulation
2. Partitioning into the stratum corneum
3. Diffusion through the stratum corneum
4. Partitioning into the aqueous viable epidermis
5. Diffusion into the dermis[14]

In topical cream formulations, oily compounds act as active substance carriers. They also serve as skin penetration enhancers and consistency or viscosity modifiers. The oily excipients may influence cream viscosity, drug solubility, physical stability, drug release performance, and transport into the skin. Oily compounds commonly used in cream formulations include saturated and unsaturated fatty acids/fatty acid esters, hydrocarbons, and polyols.

Topical cream formulations consist of the oily phase and water phase. As the two phases are immiscible, in the absence of thickeners and emulsifying agents, molecules in the topical cream formulation will form droplets. Rapid aggregation of droplets within each phase will eventually lead to phase separation. Physical stability is determined by the mitigation ability to these physical instability phenomena.

Thickeners increase cream viscosity and thus reduce dispersed droplets' mobility. They hinder the separation of phases, thereby increases the physical stability of the cream. For example, the inclusion of methylcellulose and paraffin reduces dispersed droplets' mobility in an oil-in-water emulsion and water-in-oil emulsion respectively.

Emulsifying agents can reduce the interfacial tension between the two phases, thus retards phase separation. Ionic surfactants are used in oil-in-water emulsions, whereas nonionic surfactants are used in both oil-in-water and water-in-oil formulations.[6]

Oils and fats used in topical cream formulations are susceptible to oxidation by atmospheric oxygen or microorganism action. The stability against oxidation can be enhanced by the introduction of antioxidants. The selection of antioxidants and their concentration can only be determined by testing their effectiveness on the final product, according to pharmacopoeial information. The efficiency of antioxidants depends on their compatibility with other excipients and oil/water partition coefficient.

Oxidations from microbiological source influence the physicochemical properties of the emulsion, resulting in color and odor changes, fat and oil hydrolysis, pH changes in the aqueous phase, or phase separation of the cream. Oil-in-water creams are more susceptible to microbial contamination. Therefore, preservatives are included to prevent any microorganism growth. Preservatives suitable for topical cream formulations must present a broad spectrum of bactericidal activity, low logP, compatibility with other excipients, stability, and effectiveness over a wide range of pH and temperatures.

By buffering any potential pH change, buffer agents can provide chemical stability and ensure the physical compatibility of the topical cream formulation. They ensure that the formulation can deliver the correct amount of drug to the therapeutic application site, is free from microbial contamination, and physically unchanged since the manufacturing day. Nonetheless, buffer agents need to be carefully added to avoid undesirable effects on physical stability. For example, buffer agents may influence the rheological behavior.[15]