Coal Tar: Safety in Children

Availability:

• Coal tar 1-9% oinment
• Coal Tar 20% Solution
• Coal Tar and salicyclic acid (various concentration)
• Polytar Shampoo

General

• Crude coal tar has antipsoriatic, antiseborrheic, antipruritic and keratolytic effects.
• It can be compounded in an ointment, cream or solution vehicle in concentrations from 0.5% to 20%.
• Safe, effective treatment for childhood psoriasis and is supplied in a variety of topical formulations and shampoos.
• 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
• 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.

Safety

• Preparations containing 6% coal tar : children 1 month to 2 years
• Preparations containing 10% coal tar : children above 2 years
• Shampoos containing coal tar 1-4% has been used for at least twice weekly

Dosing

• Bath:
• 60-90 mL of a 5% to 20% solution or 15-25 mL of 30% lotion is added to bath water; soak 5-20 minutes, then pat dry; use once daily to once every 3 days
• Shampoo:
• Apply twice weekly for the first 2 weeks then once weekly or more often if needed
• Skin:
• Apply to the affected area 1-4 times/day; decrease frequency to 2-3 times/week once condition has been controlled
• Atopic dermatitis:
• 2% to 5% coal tar cream may be applied once daily or every other day to reduce inflammation
• Scalp psoriasis:
• Tar oil bath or coal tar solution may be painted sparingly to the lesions 3-12 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

References:

1. BNF Children 2009
2. Lexicomp