Topical Therapy for the Management of Childhood Psoriasis: Part I

K. M. Cordoro, MD

Disclosures

Skin Therapy Letter. 2008;13(3):1-4. 

In This Article

Coal Tar

Crude coal tar has antipsoriatic, antiseborrheic, antipruritic and keratolytic effects.[4] Given its better cosmetic acceptability, liquor carbonis detergens (LCD), a modified, less clinically active coal tar, has largely replaced crude coal tar in the outpatient setting. It can be compounded in an ointment, cream or solution vehicle in concentrations from 0.5% to 20%. Tar is a safe, effective treatment for childhood psoriasis and is supplied in a variety of topical formulations and shampoos. It can be used alone or compounded with corticosteroids, lactic and salicylic acid. Its safety, efficacy, and relatively low cost, compared with other topical agents are advantages in the long-term treatment of psoriasis. Side-effects of tar include folliculitis, irritation, and photosensitivity. It should not be used on acutely inflamed skin, or on pustular or erythrodermic psoriasis.[5] There is no definitive evidence of an increased risk of skin cancer above the expected incidence for the general population from the use of therapeutic tar.[6,7] Education regarding the favorable safety profile and place in therapy as a steroid-sparing adjunct may increase tolerance and compliance of this excellent and underutilized topical therapy.

Anthralin (dithranol) is a potent anti-inflammatory and anti-proliferative agent.[8] It is a synthetic version of chrysarobin, a natural substance derived from the araroba tree of South America used to treat psoriasis for nearly 100 years.[9] Negligible systemic absorption is responsible for its excellent safety profile and ease of use, especially in children. Its use has been limited due to staining and irritation, but short contact and “minutes' therapy are popular, less messy alternatives (increasing concentrations [0.1% to 3%] of dithranol applied to the skin and left in place for 10-30 minutes daily until a slight irritation develops, then hold dose/time until clear[10]). Lower concentrations or less contact time should be maintained on more sensitive sites such as anogenital skin.

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