Coal Tar Treatment for Psoriasis: Understanding Creams, Lotions, and Topical Use

Coal tar has been a cornerstone in dermatology for over a century, particularly renowned for its effectiveness in managing psoriasis. This complex substance, derived from coal, offers relief from the persistent itching, scaling, and inflammation characteristic of skin conditions like psoriasis and seborrheic dermatitis. Understanding how coal tar works, its various forms (coal tar cream, lotion, shampoo, ointment), how to use coal tar safely, and its possible side effects is crucial for anyone considering this topical coal tar treatment. This article delves into the world of coal-tar therapy, explaining its benefits, potential risks, and providing practical guidance to help you navigate its use effectively, making it a worthwhile read for those seeking solutions for persistent skin conditions.

What Exactly is Coal Tar and How is it Used Medically?

Coal tar is a thick, dark, viscous liquid that is a byproduct of the carbonization of coal, often generated during coal gas production or the making of coke for the steel industry (coal gasification). It's a complex mixture containing thousands of compounds. While its industrial uses are vast, including paving roads and roofing, a refined form of crude coal tar has been used to treat skin conditions for well over 100 years to treat psoriasis. The medicine derived from coal tar is valued for its anti-inflammatory, anti-scaling, and anti-itching properties when applied to the skin.

Historically, dermatologists recognized the potential of coal tar to alleviate symptoms of chronic skin conditions. Early coal tar preparations were often messy and had a strong odor, but modern formulations have improved significantly in terms of cosmetic acceptability. Today, coal tar is used as an active ingredient in various over-the-counter (OTC) and prescription coal tar products, including shampoos, creams, lotions, and ointments, specifically designed for topical application. Its long history underscores its enduring role in dermatology, despite the advent of newer therapies.

The specific coal tar used in medical treatments is processed and purified to reduce potentially harmful components found in industrial coal-tar pitch. While originating from the same source material, like the High Quality Coal Tar Pitch Factory and Supplier produces for industrial applications, the medical-grade coal tar extract meets specific pharmaceutical standards. This ensures consistency and aims to minimize risks associated with its use on the skin to treat conditions like psoriasis and eczema.

How Does Coal Tar Treat Psoriasis Effectively?

The primary way coal tar helps treat psoriasis is by slowing down the rapid growth of skin cells. In psoriasis, the life cycle of skin cells accelerates dramatically, causing cells to build up rapidly on the surface of the skin, forming thick, silvery scales and itchy, dry, red patches. Coal tar contains compounds that are believed to suppress DNA synthesis in these hyperactive skin cells, effectively normalizing their growth rate. This action helps reduce the scaling, thickness, and inflammation associated with psoriatic plaques.

Furthermore, coal tar possesses anti-inflammatory and anti-itching properties. It helps to soothe the skin irritation and reduce the persistent itching that often accompanies psoriasis or eczema. By alleviating these uncomfortable symptoms, coal tar can significantly improve the quality of life for patients with psoriasis. The exact mechanism isn't fully understood due to the complexity of coal tar, but its effectiveness is well-documented through decades of clinical use.

The application of coal tar topical products directly targets the affected areas. When you massage the coal tar formulation into the psoriasis lesions as directed, it allows the active components to penetrate the skin and exert their therapeutic effects. This targeted approach helps minimize systemic exposure and focuses the treatment where it's needed most, making it an effective strategy to use coal tar to treat localized psoriasis.

Are There Different Types of Coal Tar Products Available for Psoriasis?

Yes, coal tar is available in various formulations and strengths to suit different needs and areas of the body affected by psoriasis. The choice of product often depends on the severity and location of the psoriasis, as well as patient preference. Common coal tar products include:

• Coal Tar Shampoo: Specifically designed for treating scalp psoriasis and seborrheic dermatitis of the scalp. Using a coal tar shampoo helps reduce scaling, itching, and inflammation on the head. Strengths typically range from 0.5% to 5% coal tar.
• Coal Tar Ointment: Ointments are typically thicker and more moisturizing, making them suitable for very dry, thick psoriatic plaques. They provide a good barrier and allow for prolonged contact of the coal tar with the skin.
• Coal Tar Cream: Creams are less greasy than ointments and are often preferred for daytime use or on areas where an ointment might be impractical. Coal tar cream formulations are absorbed relatively easily.
• Coal Tar Lotion: Lotions are thinner and lighter than creams, making them suitable for application over larger areas of the skin or hairy areas (other than the scalp).
• Coal Tar Gels and Solutions: These are often used for the scalp or areas where rapid drying is desired.

The strength of coal tar in these coal tar preparations can vary significantly. Over-the-counter products usually contain lower concentrations (e.g., 0.5% to 5%), while prescription products may be used with higher concentrations, sometimes up to 20% in specific formulations like pastes, often compounded by a pharmacy. Combining coal tar with other treatments, such as salicylic acid (to help remove scale) or corticosteroids (to reduce inflammation), increases the strength of coal tar's overall effect within a treatment plan. Your dermatologist may prescribe coal tar formulation best suited for your specific condition.

Is Coal Tar Safe to Use for Psoriasis Treatment?

For decades, dermatologists have been prescribing coal tar for psoriasis and seborrheic dermatitis, and when used correctly, it is generally considered safe to use for short-to-medium term treatment. Regulatory bodies like the FDA oversee the coal tar products available, ensuring they meet certain standards. However, like any medicine, coal tar is not without potential risks or side effects, and its safety profile needs careful consideration.

The main concerns historically associated with coal tar revolve around its potential messiness, odor, staining properties, and, more significantly, questions about long-term risk of skin cancer. It's important to use coal tar products exactly as directed by your healthcare provider or the product label. Avoid applying it to broken or infected skin unless specifically instructed, as this can increase absorption and irritation.

Overall, the consensus in the dermatological community is that the benefits of using coal tar for managing psoriasis symptoms often outweigh the risks, especially when compared to the impact of untreated moderate to severe psoriasis. Millions of people who use coal tar find significant relief. Open communication with your doctor about the duration of use and any concerns you have is key to ensuring coal tar is used safely and effectively as part of a treatment plan.

What are the Potential Possible Side Effects of Using Coal Tar?

While many people use coal tar without significant issues, possible side effects can occur. The most common side effects may involve localized reactions at the site of application. These can include:

• Skin irritation: Redness, stinging, or burning sensation, particularly when first starting treatment or if applied to sensitive or broken skin.
• Folliculitis: Inflammation of the hair follicles, appearing as small pimple-like bumps.
• Acne-like breakouts.
• Staining: Coal tar can stain skin, hair (especially light-colored hair), and fabrics (clothing, bedding).
• Odor: Many coal tar products have a characteristic medicinal or "tarry" smell, although newer formulations are often less pungent.
• Photosensitivity: Coal tar makes your skin more sensitive to sunlight (UV radiation). This is a crucial side effect to manage.

Less commonly, allergic reactions (dermatitis) can occur. If you experience severe irritation, blistering, or signs of an allergic reaction (like hives or difficulty breathing), stop using the product and seek medical attention immediately. It's also important to note that coal tar pitch volatiles can be irritating if inhaled, though this is more relevant for those who work with industrial coal tar, like the materials used in paving or roofing such as Ball pitch, rather than typical topical use.

If you experience any bothersome side effects, discuss them with your doctor or pharmacist. They might suggest adjusting the frequency of use, changing to a different formulation, or trying an alternative treatment. You may report side effects to FDA directly; the number is 1-800-FDA-1088. Remember to mention any effects not listed here as well.

How Should I Use Coal Tar Products Correctly for Best Results?

Proper application is key to maximizing the benefits and minimizing the side effects of coal tar treatment. Always follow the specific instructions provided with your coal tar product or by your healthcare provider. General guidelines often include:

1. Preparation: Ensure the affected skin is clean and dry before application, unless using a shampoo or bath additive. For thick scales, your doctor might recommend using a scale remover (like salicylic acid) first to allow the coal tar to penetrate better.
2. Application: Apply a thin layer of the coal tar cream, lotion, or ointment to the affected areas only. Gently massage the coal tar into the psoriasis plaques. Avoid applying it to unaffected skin or sensitive areas like the face, groin, or rectal area, unless your doctor specifically directs you to do so. Do not apply to raw, blistered, or infected skin.
3. Frequency: The frequency depends on the product and severity. It might range from once daily to several times a week. Do not use it more often than recommended. If you miss a dose, apply it as soon as you remember, but don't double up. Use it as soon as you remember, but skip the missed dose if it's almost time for the next one.
4. Scalp Treatment: When using a coal tar shampoo for scalp psoriasis, wet your hair and scalp thoroughly. Apply the shampoo, working it into a lather. Make sure the shampoo gets on your scalp itself, not just the hair. Leave it on for the recommended time (usually 3-5 minutes) before rinsing thoroughly. Repeat if directed. Be careful to avoid contact with eyes.
5. Hygiene: Wash your hands thoroughly after applying coal tar, unless your hands are the treatment area. Be mindful of staining clothes and bedding; consider wearing old items or using protective coverings after application, especially with ointments.
6. Sun Protection: Due to photosensitivity, protect treated skin from direct sunlight and artificial UV light (tanning beds). Wear protective clothing and use sunscreen on exposed treated areas when outdoors. Continue sun protection for at least 24 hours after application, as coal tar can also remain in the skin.

Consistency is crucial. It may take several weeks of regular use to see significant improvement in your psoriasis. Do not use near heat or open flame as some products may be flammable.

Can Coal Tar Be Used for Other Skin Conditions Besides Psoriasis?

Yes, while coal tar is most famously used to treat psoriasis, its properties make it effective for several other chronic skin conditions characterized by scaling, itching, and inflammation. These include:

• Seborrheic Dermatitis: This common condition causes flaky scales (often yellowish), inflammation, and redness, typically on the scalp (dandruff is a mild form), face, chest, and back. Coal tar shampoo is a mainstay treatment for scalp seborrheic dermatitis, while creams or lotions may be used on other affected areas.
• Eczema (Atopic Dermatitis): Although less common now with the availability of newer treatments, coal tar can sometimes be used to manage the itching and inflammation associated with chronic eczema. It helps to soothe irritated skin and reduce the urge to scratch.
• Other Itchy or Scaly Conditions: Occasionally, dermatologists might recommend coal tar for other less common dermatoses involving scaling or persistent itching.

The specific coal tar preparation and concentration will vary depending on the condition being treated and its location. For instance, lower concentrations might be used for facial seborrheic dermatitis compared to thick psoriatic plaques on the elbows. Its broad action against inflammation, scaling, and itching makes coal tar a versatile tool to treat skin conditions under medical supervision.

What Should I Discuss with My Doctor Before Starting Coal Tar Treatment?

Before you begin using any coal tar product, especially prescription-strength ones, it's essential to have a thorough discussion with your doctor or dermatologist. They need your complete medical history to determine if coal tar is used appropriately and safely for you. Key points to discuss include:

• Your Diagnosis: Confirm that your skin condition is indeed one that responds well to coal tar (like psoriasis, seborrheic dermatitis, or certain types of eczema).
• Medical History: Inform your doctor about any other medical conditions you have, especially any history of skin cancer, sun sensitivity disorders, or allergies. Mention if you are pregnant, planning pregnancy, or breastfeeding.
• Current Medications & Treatments: Provide a list of all medications you are currently taking (prescription, OTC, supplements, herbals) and any other topical treatments you are using on your skin. Some medications can increase sun sensitivity, compounding the effect of coal tar.
• Previous Experiences: Let them know if you have used coal tar before and what your experience was (effectiveness, side effects).
• Lifestyle Factors: Discuss your level of sun exposure and ability to comply with sun protection measures.
• Treatment Goals & Expectations: Talk about what you hope to achieve with the coal tar treatment and understand the potential timeline for seeing results.

Your doctor can then explain the specific coal tar product they recommend (shampoo, ointment, lotion, etc.), its strength, how to use coal tar correctly, potential side effects, and how it fits into your overall treatment plan. They may prescribe coal tar alone or in combination with other therapies. This conversation ensures you start the coal tar treatment informed and prepared.

Coal Tar and Sun Sensitivity: What Do I Need to Know?

One of the most significant considerations when using coal tar is that it makes your skin more sensitive to ultraviolet (UV) light, both from the sun and artificial sources like tanning beds or phototherapy lamps. This is called photosensitivity. Exposure to coal tar followed by UV light can lead to exaggerated sunburn reactions, potentially severe, on the treated areas.

Therefore, strict sun protection is crucial while using coal tar and for at least 24 hours after the last application (some sources recommend up to 72 hours, so follow your doctor's advice). Key precautions include:

• Avoid Direct Sunlight: Minimize time spent outdoors, especially during peak sun hours (typically 10 am to 4 pm).
• Wear Protective Clothing: Cover treated skin with long-sleeved shirts, long pants, and wide-brimmed hats when outdoors.
• Use Broad-Spectrum Sunscreen: Apply a high-SPF (30 or higher) broad-spectrum sunscreen generously to any treated skin that cannot be covered by clothing. Reapply frequently, especially after swimming or sweating.
• Avoid Tanning Beds: Do not use tanning beds or sunlamps while using coal tar.
• Inform Phototherapy Providers: If you are undergoing UV light therapy (phototherapy) for your psoriasis, ensure your dermatologist is aware you are also using coal tar, as dosages may need adjustment. This combination (Goeckerman regimen) is sometimes used intentionally under strict medical supervision, as coal tar can enhance the effects of UV light, but it requires careful monitoring due to the increased risk of burns.

Understanding and managing this sun sensitivity is vital for using coal tar safely and avoiding painful burns or potential long-term skin damage. If you know you will have significant sun exposure, discuss it with your doctor before starting coal tar treatment.

Does Long-Term Use of Coal Tar Increase Cancer Risk?

The question of whether long-term use of coal tar increases the risk of skin cancer has been debated for many years. This concern arises primarily from studies of industrial workers with high levels of occupational exposure to coal tar (e.g., chimney sweeps, gas workers, those working with coal tar pitch in roofing or paving) who showed increased rates of certain cancers, including skin cancer. Crude coal tar and coal tar pitch volatiles contain known carcinogens.

However, translating this occupational risk to the topical use of medicinal coal tar preparations for skin conditions such as psoriasis is complex. Medicinal coal tar is more refined, used in lower concentrations, applied to limited body surface areas, and typically for intermittent periods rather than continuous, high-dose occupational exposure. Numerous studies have found varying results regarding the risk of cancer associated with therapeutic coal tar. Some large-scale epidemiological studies following patients with psoriasis who used coal tar regularly did not find a significantly increased risk of skin cancer compared to psoriasis patients using other treatments or the general population. Psoriasis itself carries a slightly increased risk for some cancers, further complicating the analysis.

While a definitive "zero risk" cannot be stated, the consensus among many dermatologists, supported by major dermatology organizations and regulatory bodies like the FDA (which continues to permit OTC coal tar products), is that the benefits of using coal tar for psoriasis and seborrheic dermatitis generally outweigh the potential risk of cancer when used appropriately and under guidance. Nevertheless, it's prudent to:

• Use coal tar only as directed and for the recommended duration.
• Avoid applying it to sensitive areas or broken skin unless advised.
• Practice strict sun protection, as UV exposure is a known risk factor for skin cancer.
• Have regular skin checks with your dermatologist, especially if you have psoriasis or use coal tar long-term. Discuss any concerns about long-term use and the risk of skin cancer openly with your doctor. They can provide personalized advice based on your condition and medical history.

Key Takeaways:

• Coal tar is a long-established topical treatment used to treat psoriasis, seborrheic dermatitis, and eczema.
• It works primarily by slowing down excessive skin cell growth and reducing inflammation, scaling, and itching.
• Coal tar products come in various forms (shampoo, ointment, cream, lotion) and strengths.
• Common possible side effects include skin irritation, staining, odor, and significantly increased sensitivity to sunlight (photosensitivity).
• Proper usage involves applying thinly to affected areas, following frequency guidelines, and practicing meticulous sun protection.
• While concerns about long-term use and risk of skin cancer exist due to industrial exposure data, studies on therapeutic use haven't shown a significant increase in risk for most patients when used correctly.
• Always use coal tar under the guidance of a healthcare professional, discussing your medical history, potential risks, and correct application techniques. You can report side effects to FDA at 1-800-FDA-1088.

Disclaimer: This article provides general information about coal tar and its use in psoriasis. It is not a substitute for professional medical advice. Always consult your doctor or dermatologist for diagnosis and treatment recommendations specific to your condition.