Nearly one-third of the world’s population suffers from skin disorders, which rank as the fourth most common non-fatal disease burden worldwide (1), with an annual percent increase of 46.8% between 1990 and 2017 (2, 3). Skin conditions are among the most prevalent health issues in the world and have a significant financial and health impact. The psychological, social, and financial effects of skin disease on patients, their families, and society at large are all included in the multifaceted concept of the burden of skin disease. The two most prevalent skin conditions in poor nations are scabies and psoriasis (4, 5). In Ethiopia, dermatological issues account for 25% of cases in the Outpatient Department (OPD), making it one of the main reasons patients visit hospitals. Psychosocial consequences from skin diseases can have a major negative impact on patients’ quality of life (6).

Pharmaceutical compounding involves the combination, mixing, diluting, reconstructing, or alteration of a drug/bulk drug substance to create medications tailored to individual patient needs (7). It is an art or science to combine various chemical elements into a functional medicament. Extemporaneously compounded products are prepared specifically for an individual patient for immediate use and may include modifications to commercially manufactured products, such as the preparation of a suspension from tablets or the preparation of a product from individual raw materials (8).

Extemporaneous compounding is still a vital pharmaceutical service that continues to provide crucial patient populations with access to life-saving medications despite the development of commercial pharmaceutical manufacture and the widespread availability of contemporary medications (9, 10). One advantage of extemporaneously compounded products over commercial products is their flexibility for individual needs. Moreover, they have paramount importance in cases where individuals are sensitive to the ingredients of commercially available products, and even they may become the only way someone can receive a treatment that has been deemed insufficiently profitable by pharmaceutical companies (9–11).

Errors in extemporaneous compounding can occur at any point in the process, from prescribing medication to giving the patient their ready medication. Incorrect calculations and microbiological contamination are among the most serious errors, which may result in death. There were cases reported where the active component was absent from the final compounded preparation, where the active ingredient or excipients were wrong, or where the product was packaged incorrectly. It is crucial to note that unfavorable precipitation or nonhomogeneous mixing may arise from physicochemical problems, disregard for preparation guidelines, or improper preparation technology of extemporaneous medicines (12–14).

Ethiopian pharmacy practice, which included pharmaceutical compounding and manufacturing, was discovered at a very young age and was virtually forgotten in hospital settings (15). Recently, the Ministry of Health in Ethiopia has paid some attention to this service, which is regarded as one endeavor. Dermatological preparations are one of the services that a technical working group has been formed to help public hospitals provide this service (12, 15, 16).

Currently, many hospitals and community pharmacists in Ethiopia are increasingly incorporating the practice of extemporaneous compounding into their existing services (Box 1). However, data is lacking on the practice of prescribing, compounding, and use of extemporaneously compounded products in many hospitals. In addition, gaps have been observed in the facilities with the country’s regulatory requirements and their quality, efficacy, and safety (12, 16, 17). The safety, quality, and performance of compounded preparations depend on correct ingredients and calculations, accurate and precise measurements, and appropriate formulation conditions and procedures (12, 17).

Therefore, this study evaluated the existing practice of prescribing and compounding extemporaneous dermatological preparations, the applicability of extemporaneous compounding guidelines, and identified the most common dermatological diseases and the most commonly prescribed extemporaneous dermatological preparations at five randomly selected hospitals in northwest Ethiopia.

Most patients in this study were female, and females were more likely to suffer from autoimmune and allergy diseases as well as skin conditions such as psychosomatic issues, pigmentary disorders, specific hair diseases, and psychosomatic problems. Although differences in skin structure and physiology due to the impact of sex hormones may influence gender disparities in skin diseases, the processes behind these differences remain largely unclear (18).

Melasma was found to predominantly affect female patients (82.9%) in the age group of 30–64 years (46.7%), this result is similar to previous studies as epidemiological review showed a clear female predominance was observed in the reports of the disease, ranging from 9 or 10 to 1 (19). This could be because female sex hormones are well-known risk factors for the development of melasma, and their preponderance in fertile women reinforces this hypothesis (20). In contrast to earlier research among Nigerian undergraduates, where there was a substantial difference between the severity of acne in males and females, acne vulgaris was the second most prevalent dermatological issue among females (68.6%), and mostly affected the age period of 18–29 years (68.6%) (21, 22). The female predominance in this study could be because stress is a significant factor in acne and females are more likely than males to suffer from stress-related depressive disorders and anxiety (23).

For most skin conditions in this study, extemporaneous dermatological products were prescribed for patients above the age of 18 years, and this result is similar to that of a previous study. For majority of skin problems, compounded dermatological products were meant for adults and older adult patients. The possible reason is dosage modifications or combining commercial products, which is considered in the study’s finding that the majority (56.3%) of prescriptions carry the combined drugs (5). This finding is opposite to other studies in which children under 12 years of age received relatively more extemporaneous compounded dermatological medicines than other age groups, which could be due to the need for the patient to be fashioned or fitted to resemble a tailor’s therapy for children (24–27).

The majority (60.76%) of compounded prescriptions carry two or more drugs, which is supported by other similar studies in ALERT hospital, were the majority of prescriptions (65%) carry more than one active pharmaceutical substance (5). However, the rate was greater than in our study in the compounded prescription pattern study carried out in Jogjakarta Province hospital (28) because of the nature of some skin disorders that could respond to a single active medicinal ingredient. A survey of Australian general practitioners mentioned these as the major reasons for prescribing certain extemporaneous formulations (29).

Among prescribed drugs, salicylic acid (35.39%) and clobetasone (13.03%) were the most commonly used active pharmaceutical substances in the hospital for extemporaneous compounded products, which is similar to a previous study in which salicylic acid (38.0%) was the most commonly used ingredients (2). Therefore, their continued availability is necssary to satisfy the specific needs of patients. In contrast to clobetasone, which was purchased as a cream from the market and used for compounding, salicylic acid is available in the hospital in powder form.

Ointments and creams comprised the majority of dose forms from the compounded products in the study area, which is consistent with other similar studies (26, 30, 31). Dermatological treatments offered in the form of these dosage forms may be due to the type of skin lesions (dry or leaking moisture) found on patients and the ease of accessibility to vehicle agents.

Several semisolid formulations are available for topical applications intended to address the type and location of skin problems. Ointments are substances used on the skin to soothe or heal wounds, burns, rashes, scrapes, and other skin problems. Also called unguent. The possible reason for the preference of these semisolid dosage forms is their ease of application, rapid formulation, and ability to topically deliver a wide variety of drug molecules compared with the application site in liquid preparations (18, 23).

Dermatological disease is more prevalent in the study area. Females are mostly affected. The four top prevalent dermatological diseases are: melasma, acne vulgaris, acute dermatitis, and rosacea. Extemporaneous topical semisolid preparations containing two or more active ingredients are the most widely compounded and prescribed products for pharmaceutical care. Salicylic acid, clobetasone, and betametasone are widely used active pharmaceutical ingredients. Vaseline and Nivea cream are the most commonly used vehicles for compounding preparations. Hydroquinone (4%) with Nivea cream (30gm), Salicylic acid (5%) + Betametasone (75 g) + Vaseline (20 g) were the most commonly prescribed dermatological formulations. There are concerns related to the applicability of a country regulatory requirements and good manufacturing practices, and their efficacy, quality, and safety. So, this study suggests that application of good manufacturing practices and compounding guidelines for extemporaneous compounding of dermatological formulations to ensure efficacy, quality, and safety.