|
No
|
Year
|
Title
|
Finding(s)
|
Reference(s)
|
||||||||||||
|
1
|
2020
|
Bluebook / FUKKM
[online]
|
|
-
|
||||||||||||
|
2
|
2019
|
Miscellaneous
External Drug Products For Over-the-counter Human Use (Code of Federal Regulations Title 21)
|
Subpart H - Drug Products
for the Control of Dandruff, Seborrheic Dermatitis, and Psoriasis Sec. 358.710 Active ingredients for the
control of dandruff, seborrheic dermatitis, or psoriasis
·
Active ingredients for the control of seborrheic dermatitisand psoriasis. Coal tar, 0.5 to 5
percent. When a coal tar solution,
derivative, or fraction is used as the source of the coal tar, the labelling shall
specify the identity and concentration of the coal tar source used and the concentration of the coal tar presentin the final
productà OTC Products
|
CFR - Code
of Federal Regulations Title 21. (n.d.). www.accessdata.fda.gov. Retrieved July
21, 2020, from https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=358.710&SearchTerm=coal%20tar
|
||||||||||||
|
3
|
2016
|
Management of scalp psoriasis: current perspectives
|
i) Shampoo: There are some
studies available that support the use
of coal tar shampoo, containing 2% – 10% coal tar solution, in scalp
psoriasis; however, no double-blind studies are available to support this
practice and many patients do not find tar shampoos cosmetically acceptable.
Salicylic acid shampoo, due to its keratolyticeffect, has also been used to
enhance the penetration of other topical medications including
corticosteroids, and has been recommended by The National Psoriasis
Foundation as a first-line therapy. However, a recent Cochrane review of
clinical trials on scalp psoriasis found no evidence to support the first-line
use of a tar-based shampoo, with or without a keratolytic such as salicylic
acid.
ii) Topical: Coal tar has been
used as a treatment for psoriasis for several decades due to its
anti-proliferative and anti-inflammatory actions, and its potent anti-pruritic
properties. Although crude coal tar is the most effective tar available for
the treatment of psoriasis, the application of crude coal tar to the scalp
presents a challenge. As such, coal
tar solution or liquor carbonisdetergens 5% – 20% is frequently recommended,
formulated as a lotion, or added to a corticosteroid preparation. Of
note, the use of coal tar has largely fallen out of favor to newer topical
medications. Tar’s malodour, adverse effects (hair staining and drying), and
carcinogenicity limit its use, although newer studies challenge these
findings. The use of coal tar in cosmetic preparations has been banned
in Canada and the European Union over concerns regarding carcinogenicity.
|
Blakely, K.,
& Gooderham, M. (2016, March 29). Management of scalp psoriasis:
current perspectives. Psoriasis: Targets and Therapy. https://www.dovepress.com/management-of-scalp-psoriasis-current-perspectives-peer-reviewed-fulltext-article-PTT
|
||||||||||||
|
4
|
2018
|
Topical Preparations Counselling Guide for Pharmacist (1st
edition)
|
Coal tar solution 20%
• 1 cap (15
mL) added to 10L of water in a pail
• Soak
diluted solution for 20 minutes
• Do not
rinse again with tap water
|
-
|
||||||||||||
|
5
|
-
|
Coal tar
|
Topical/Cutaneous
Dandruff, Seborrheic dermatitis
Adult: As 1%, 2.5% shampoo: Massage into we
scalp. Leave for several minutes then rinse thoroughly. May use up to twice
weekly.
Child: Same as adult dose. Elderly: Same as adult dose.
Topical/Cutaneous
Psoriasis of skin and scalp
Adult: As a 5% emulsion: Apply a thin layer 2-3
times daily to affected areas, massage gently and leave to dry.
Child: >12 years Same as adult dose. Elderly: Same as adult dose. |
(2020).
mims.com. https://www.mims.com/malaysia/drug/info/coal%20tar?mtype=generic
|
||||||||||||
|
6
|
-
|
Coal tar: Drug information
(Dosing for Adult)
|
Seborrhea,
dermatitis: Topical:
Skin: Apply to the affected area 1 to 4 times/day; decrease
frequency to 2 to 3 times/week once condition has been controlled
Bath: Add appropriate amount to bath water, for adults usually
60-90 mL of a 5% to 20% solution or 15 to 25 mL of 30% lotion; soak 5 to 20
minutes, then pat dry; use once daily to every 3 days
Dandruff:
Shampoo: Rub shampoo onto wet hair and scalp, rinse
thoroughly; repeat; leave on 5 minutes; rinse thoroughly; apply twice weekly
for the first 2 weeks then once weekly or more often if needed
Psoriasis:
Topical:
Scalp
psoriasis: Tar oil bath or coal tar
solution may be painted sparingly to the lesions 3 to 12 hours before each
shampoo
Psoriasis
of the body, arms, legs: Apply at bedtime; if
thick scales are present, use product with salicylic acid and apply several
times during the day
|
UpToDate
|
||||||||||||
|
7
|
1974
|
British
Medical Journal
|
Tar bath: 120
ml coal tar solution B.P. in a 20-gallon bath
**Coal tar solution BP = Coal tar solution 20%
***20
gallon ≈ 76L
|
Stankler, P.
(1974). BRITISH MEDICAL JOURNAL Today’s Treatment Diseases of the
Skin. https://www.bmj.com/content/bmj/1/5896/27.full.pdf
|
||||||||||||
|
8
|
-
|
Coal tar and carcinogenicity
|
Coal tar products containing coal tar above a concentration of 5% are listed by the World Health
Organisation as carcinogenic.
However, reviews of the literature have been unable
to uncover evidence of increased risk of cancer in those treated with medical
formulations of coal tar. Studies of patients receiving long term treatment
with coal tar have also not found
evidence of an increased risk of cancer. A recent in depth analysis of
patients receiving tar based anti-psoriasis treatment compared with
alternative medications found no
evidence of an increased risk of skin cancer associated with tar.
From latest studies, coal tar is found to be
carcinogenic in animals, but in humans, there are no convincing data proving
carcinogenicity, and epidemiologic studies fail to show increased risk of
skin cancer in patients who use coal tar.
|
Section
13.4 Dermatological medicines (topical) -Medicines affecting skin
differentiation and proliferation Coal tar. (n.d.). Retrieved July 21, 2020, from https://www.who.int/selection_medicines/committees/expert/19/applications/Coaltar_13_4_A_R.pdf
|
Summary:
Comparison of Concentrations
|
|
Reference
|
Shampoo
|
Bath
|
Topical
|
|
1
|
Bluebook/FUKKM
Online (2020)
|
|
Add 100ml of
20% into a bath
|
1-9% ointment
|
|
2
|
Management of
scalp psoriasis: current perspectives (2016)
|
2-10%
|
|
5-20% (as a
lotion / added to a corticosteroid preparation.
|
|
3
|
Topical
Preparations Counselling Guide for Pharmacist (1st edition) 2018
|
|
15 ml of 20% à 10 L water
|
|
|
4
|
MIMS online:
Coal tar
|
1-2.5%
|
|
5% for psoriasis
of skin and scalp
Cream 6% available
|
|
5
|
UptoDate:
Drug Information: Coal Tar
|
|
60-90 mL of
20% solution to appropriate amount of bath water
|
|
|
6
|
British
Medical Journal 1974
|
|
120 ml of 20%
à 76 L water
|
|
|
7
|
Micromedex
coal tar products
|
0.5-5%
|
|
2-3% (except
Oxipor VHC: lotion 25%)
|
|
8
|
UptoDate:
coal tar products
|
0.5-10%
|
|
2-10%
|
All accessed on 22 July 2020 [Prepared by Noratikah ;
Edited by JCK Ho]
