Tar in dermatology,uses ,side effects and contraindications

1. ANAND
Coal TarA short talk

2. Tar -3 Types
• Wood Tar:- Juniper tar, Pine tar ,Birch tar
• Shale Tar:- Icthammol (Icthyol)
• Coal Tar:- Liquor picis carbonis(LCD)

3. Wood Tar
• Distillation of wood under controlled conditions
• Most commonly from juniper (oil of cade)
• Also be derived from Peech, birch & pine
• Can be added to peanut oil or other bases
• Typically used to treat scalp psoriasis
• Contact sensitivity been reported
• Not photosensitive

5. Shale tar
• From sedimentary rock ( Fossilised fish)
• Also known as bituminous tar
• Eg:-Icthammol/ Icthyol (It has sulphr 10%)
• Antiseptic & anti inflammatory action
• Less effective than coal tar
• Not photsensitive

6. Coal Tar

7. COAL
(1Ton)
Solids(70%)
Coke breeze
Gas
Coke gas
Liquids
Tar(10 gallons)
Amm sulphate & liquor
Light oil
Coke Oven

8. Coal Tar
• Coal tar has been used to treat inflammatory
dermatoses for up to 2 millennia
• 2000 yrs old(Asphalt used in 20 AD)
• By product of dry distillation of Coal heated in
absence of Oxygen
• Used primarily to treat psoriasis

9. Coal Tar
• Thick Brown black Viscous liquid
• Slightly water soluble
• Specific activity of each constituents is
unknown(400/10,000 been identified)
• Only 55% of its contents
• Pharmacology of coal tar has not been
standardised

10. • Aromatic ,Complex substance
• Crude coal tar -48% HC, 42% Carbon & 10 % Water
• 02-10%-Middle oil-Phenol,cresol,naphthalene
• 02-08%-Light oil-Benzene,Toluene
• 16-20%-Anthracene oil
• 50%-Pitch
• Coal Pitch-Photosensitiser (330-550nm)-(VL &UV A)

12. 0.5-10% -In a broad array of vehicles

13. • Liquor carbonis detergens:- 20g Coal Tar with
100ml Alcohol & emulsifying with
5g of Tween 80
• Most often obtained in solution form
(0.1 to 20%) and mixed with ingredients, such
as salicylic acid & sulphur to make lotions,
creams, ointments & shampoos

14. (1884-1954)

15. • Goeckermans regimen- 1925
• 2-6 % CT in petrolatum for 2-24 hrs
• Wiped off with mineral oil …..followed by UV light
• (Decreased blood flow in psoriatic lesions of
patients treated with Goeckerman regime)
• Isoquinoline may be the antipsoriatic constituent
in Coal tar

16. Mechanism of action
• It depresses epidermal DNA synthesis
• Reducing mitotic activity in basal layers of
epidermis
• Initial transient hyperplasia followed by 20%
reduction in epidermal thickness after 40
days-On application to the skin

17. Other Actions
• Anti inflammatory
• Anti-infective
• Antipruritic
• Decreases Sebum secretion
• Photosensitizing & Vasoconstrictive effects

18. How to use coal tar
• Apply at bedtime to avoid problem of smell & staining
during day
• Cover with bandages to stay in place & prevent staining.
• Plastic wrap may cause irritation & infection
• On scalp, apply with a downward stroke in the direction of
hair growth
• Do not apply to infected, raw or oozing areas of the skin
• After applying coal tar , protect the treated area from
direct sunlight & do not use a sunlamp
• Avoid mucosa
• Cautious use over groin & rectal region

19. Coal Tar Bath
• Adults:-150-200 litres
• Children :-50-60 litres of water
• 100ml of coal tar solution should be added to
a standard bath of warm water
• Soak in this water for five minutes then pat
the skin dry

20. Indications
• Scalp Psoriasis
• Plaque psoriasis
• Atopic dermatitis
• Discoid eczema
• Seborrheic dermatitis
• Tufted hair folliculitis
• Palmoplantar pustulosis

21. • Application of coal tar provides local relief,
while softening dry skin and peeling off
excessively hard, scaly and roughened skin.
• Coal tar derivatives like acetanilide,
phenacetin, & paracetamol (acetaminophen)
are pain killers
• Paracetamol is the only coal-tar derived
analgesic still in use today

22. • Systemic adverse effects -uncommon,
whereas local adverse effects are present
• Newer formulations, however, might be better
tolerated

23. Disadvantages & Adverse effects
• Smell
• Appearance
• Staining of clothes
• Acneiform eruptions
• Contact dermatitis
• Folliculitis
• Skin cancer risk –Not significant
(Anthracene,Benzpyrene)

24. • Stinging
• Burning sensation
• Atrophy
• Telengiectasias
• Pigmentation(Melanoses)
• Exfoliative dermatitis
• Keratoacanthomas
• Papilloma
• Avoided in pregnancy & Lactation (Category C)

25. Complications
• Coal Tar Acne:-
Comedonal type
Around eyes & malar region
Clears rapidly after the exposure ceases
• “Tar smarts” (Skin pain) & Erythema
following exposure to UVA

26. • The dirtier , blacker & smellier the coaltar
fraction , the more effective it is in psoriasis
• Salicylic acid is often added -Enhances coal tar
absorption by its keratolytic effect
• Allergy for wood tar in patch test –Indicator of
Perfume allergy

27. Atopic dermatitis
• Before the advent of Corticosteroids
• Preparations containing Coal tar & icthammol
used in maintaining pt with lichenification
• 1-10% coal tar solution in an oint /cream base
is preferred to crude coal tar
• Icthammol can be used with plastic bandages

28. Seborrheic dermatitits-Scalp
• Normalises epidermal differentiation
• Decreases scaling
• Found to be useful with Zinc pyrithione
• Applied and kept for 30 min and washed off

29. Thank You