Coal Tar + Precipitated Sulphur + Salicylic Acid

• Psoriasis: Management of mild to moderate chronic plaque psoriasis, targeting scaling, itching, and inflammation.
• Seborrheic Dermatitis: Relief of itching, scaling, and redness of the scalp and skin associated with seborrheic dermatitis.
• Chronic Eczema and Dermatitis: Adjunctive therapy to reduce hyperkeratosis and inflammation in chronic eczematous conditions.
• Other Hyperkeratotic Dermatoses: Treatment of lichen simplex chronicus, ichthyosis, and related skin disorders characterized by thickened, scaly plaques.

• Formulations: Available as medicated creams, ointments, or lotions combining all three active ingredients.
• Adults: Apply a thin layer to affected skin once or twice daily, or as directed by a physician.
• Pediatrics: Use with caution; generally avoided or used under medical supervision due to potential irritation.
• Elderly: Same as adults; monitor for skin irritation.
• Duration: Continue treatment until clinical improvement; maintenance therapy may be required for chronic conditions.
• Special considerations: Avoid application on broken or inflamed skin and mucous membranes.
• Administration instructions: Wash hands before and after application; avoid contact with eyes.

• Coal Tar: Acts as a keratoplastic and antiproliferative agent, slowing epidermal cell proliferation and reducing scaling and inflammation.
• Precipitated Sulphur: Exhibits keratolytic, antibacterial, antifungal, and antiparasitic properties; promotes shedding of dead skin cells and reduces microbial colonization.
• Salicylic Acid: Functions primarily as a keratolytic, breaking down intercellular connections (desmosomes) in the stratum corneum to soften and remove scales and plaques, facilitating penetration of other agents.
  Combined, these agents synergistically reduce hyperkeratosis, inflammation, itching, and microbial growth in various chronic skin conditions.

• Absorption: Minimal systemic absorption when applied topically to intact skin; increased absorption possible if skin is damaged or inflamed.
• Distribution: Primarily localized to the stratum corneum and epidermis.
• Metabolism: Coal tar components and salicylic acid are metabolized locally in the skin; absorbed salicylates are metabolized hepatically.
• Excretion: Systemic metabolites of salicylic acid are excreted via urine; coal tar components mostly remain localized.
• Onset of action: Symptomatic relief may occur within days; clinical improvement typically over weeks with regular use.

• Pregnancy: No well-controlled studies; use only if potential benefits justify potential risks.
• Lactation: Limited data; topical application with minimal systemic absorption likely low risk; caution advised.

• Primary Class: Dermatologic Combination Product
• Subclass: Keratolytic, Antiproliferative, Antimicrobial Agent Combination

• Known hypersensitivity to coal tar, sulphur, salicylic acid, or any excipients.
• Application on open wounds, ulcers, or severely inflamed or broken skin.
• History of photosensitivity reactions to coal tar or salicylic acid.

• Prolonged use on large skin areas may increase risk of irritation or sensitization.
• Potential photosensitivity; avoid excessive sunlight or UV exposure during and shortly after treatment.
• Avoid contact with eyes, mucous membranes, and genitals.
• Use cautiously in patients with renal or hepatic impairment due to possible systemic absorption of salicylates.
• Discontinue if severe irritation, rash, or allergic reaction occurs.
• Not recommended for use in children under 2 years without specialist advice.

Common:

• Local irritation, burning, stinging, redness.
• Dryness or peeling of skin.

Rare/Serious:

• Allergic contact dermatitis.
• Photosensitivity reactions.
• Systemic salicylate toxicity (very rare, with excessive use over large areas).

• May potentiate effects of other topical irritants, increasing risk of dermatitis.
• Avoid concurrent use with strong photosensitizing agents.
• No significant systemic drug interactions expected with topical use.

• Current dermatology guidelines recognize this combination as an effective, cost-efficient option for mild to moderate hyperkeratotic dermatoses.
• Emphasis on monitoring for photosensitivity and skin irritation with combination keratolytic treatments.
• Newer formulations aim to reduce odor and improve cosmetic acceptability to enhance patient compliance.

• Store at 20°C to 25°C (68°F to 77°F) in a tightly closed container.
• Protect from light and moisture.
• Keep away from flames or sparks; coal tar preparations may be flammable.
• Do not freeze.
• Keep out of reach of children.