Coal Tar

• Psoriasis: Topical treatment for mild to moderate chronic plaque psoriasis to reduce scaling, itching, and inflammation.
• Seborrheic Dermatitis: Management of scalp and skin seborrheic dermatitis symptoms including flaking, itching, and redness.
• Atopic Dermatitis (Eczema): Adjunctive therapy for controlling symptoms such as itching and scaling.
• Other Dermatoses: Occasionally used in treatment of chronic eczema, lichen simplex chronicus, and other hyperproliferative skin conditions.

• Formulations: Available as creams, ointments, lotions, shampoos, and solutions.
• Adults:
• Apply topically to affected skin once or twice daily as directed by a physician.
• For scalp conditions, use medicated shampoo 2–3 times per week; leave on scalp 3–5 minutes before rinsing.
• Pediatrics: Use with caution; typically lower concentration formulations recommended.
• Elderly: Same as adults; monitor skin for irritation.
• Duration: Treatment duration varies; typically continued until symptoms improve, with maintenance therapy as needed.
• Special Populations: Avoid application to broken or irritated skin; use cautiously in sensitive areas.
• Administration Instructions: Wash hands before and after application; avoid contact with eyes and mucous membranes.

Coal tar is a complex mixture of phenols, polycyclic aromatic hydrocarbons, and other organic compounds that exhibit keratoplastic, anti-inflammatory, antipruritic, and antimicrobial effects. It slows down the rapid proliferation of epidermal cells characteristic of psoriasis and other dermatoses by inhibiting DNA synthesis in hyperproliferative keratinocytes. Coal tar also reduces inflammation and scaling by suppressing epidermal mitotic activity and exerting a mild antiseptic effect, helping to control itching and skin irritation.

• Absorption: Minimal systemic absorption through intact skin; increased absorption possible through broken or inflamed skin.
• Distribution: Primarily remains localized to the stratum corneum and epidermis.
• Metabolism: Metabolized locally in the skin; systemic metabolism is minimal due to low absorption.
• Excretion: Any absorbed components are metabolized by the liver and excreted mainly via urine and feces.
• Onset of Action: Symptom improvement may be observed within days to weeks of consistent use.

• Pregnancy: No established FDA category; limited human data. Use during pregnancy only if potential benefits justify potential risks.
• Lactation: Minimal systemic absorption suggests low risk; however, caution is advised when applying to large skin areas or broken skin in nursing mothers.

• Primary Class: Dermatological Agent
• Subclass: Keratoplastic, Anti-psoriatic Agent

• Known hypersensitivity to coal tar or any excipients in the formulation.
• Application on open wounds, ulcers, or severely irritated skin.
• History of photodermatitis or photosensitivity reactions related to coal tar.

• Prolonged use on large skin areas may increase risk of skin irritation or sensitization.
• Potential carcinogenicity concerns exist with long-term, high-concentration exposure; use lowest effective concentration and duration.
• Avoid exposure to sunlight or UV light during and shortly after application to reduce risk of photosensitivity.
• Avoid contact with eyes, mucous membranes, and genitals.
• Discontinue if severe irritation, redness, or allergic reaction occurs.
• Not recommended for use in children under 2 years without specialist advice.

Common:

• Local irritation, burning, stinging, or redness at application site.
• Photosensitivity reactions (rash, itching, blistering).

Rare/Serious:

• Allergic contact dermatitis.
• Folliculitis or skin infection with prolonged use.
• Potential carcinogenicity with chronic extensive use (mainly based on animal studies).

• May interact with other topical agents; simultaneous use with other irritants may increase risk of skin irritation.
• Avoid combining with strong photosensitizers.
• No significant systemic drug interactions due to minimal systemic absorption.

• Current dermatology guidelines recommend coal tar as an effective adjunct treatment in mild to moderate psoriasis and seborrheic dermatitis.
• Use of coal tar products with lower concentrations and improved formulations aims to enhance safety and patient adherence.
• Emphasis on caution regarding photosensitivity and potential carcinogenicity with long-term use.
• Alternative newer therapies often preferred for long-term management, but coal tar remains valuable in resource-limited settings.

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