coal tar in dermatology, anand
TRANSCRIPT
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ANAND
Coal TarA short talk
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Tar -3 Types
• Wood Tar:- Juniper tar, Pine tar ,Birch tar• Shale Tar:- Icthammol (Icthyol)• Coal Tar:- Liquor picis carbonis(LCD)
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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
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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
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Coal Tar
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COAL (1Ton)
Solids(70%)Coke breeze
GasCoke gas
LiquidsTar(10 gallons)
Amm sulphate & liquor Light oil
Coke Oven
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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
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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
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• 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)
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0.5-10% -In a broad array of vehicles
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• 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
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(1884-1954)
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• 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
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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
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Other Actions
• Anti inflammatory• Anti-infective• Antipruritic • Decreases Sebum secretion• Photosensitizing & Vasoconstrictive effects
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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
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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
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Indications
• Scalp Psoriasis• Plaque psoriasis• Atopic dermatitis• Discoid eczema• Seborrheic dermatitis• Tufted hair folliculitis• Palmoplantar pustulosis
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• 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
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• Systemic adverse effects -uncommon, whereas local adverse effects are present
• Newer formulations, however, might be better tolerated
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Disadvantages & Adverse effects
• Smell• Appearance• Staining of clothes• Acneiform eruptions• Contact dermatitis• Folliculitis• Skin cancer risk –Not significant
(Anthracene,Benzpyrene)
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• Stinging• Burning sensation• Atrophy• Telengiectasias• Pigmentation(Melanoses)• Exfoliative dermatitis• Keratoacanthomas• Papilloma• Avoided in pregnancy & Lactation (Category C)
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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
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• 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
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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
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Seborrheic dermatitits-Scalp
• Normalises epidermal differentiation• Decreases scaling• Found to be useful with Zinc pyrithione• Applied and kept for 30 min and washed off
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Thank You