Coal tar in Dermatology, Anand

Tar in dermatology,uses ,side effects and contraindications

1. ANAND Coal Tar A short t alk

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 D istillation of wood under controlled conditions Most commonly from juniper (oil of cade) A lso 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

4. 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

5. Coal Tar

6. 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 C oal heated in absence of Oxygen Used primarily to treat psoriasis

7. Coal Tar Thick Brown black Viscous liquid S lightly 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

8. 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)

9. 0.5-10% -In a broad array of vehicles

10. 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

11. (1884-1954)

12. 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

13. 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

14. Other Actions Anti inflammatory Anti-infective A ntipruritic Decreases Sebum secretion Photosensitizing & Vasoconstrictive effects

15. 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 O n 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

16. 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

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

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

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

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

21. Stinging Burning sensation Atrophy Telengiectasias Pigmentation( Melanoses ) E xfoliative dermatitis Keratoacanthomas Papilloma Avoided in pregnancy & Lactation (Category C)

22. 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

23. 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

24. 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

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

26. Thank You