Coal Tar

No	Year	Title	Finding(s)	Reference(s)
1	2020	Bluebook / FUKKM [online]	Generic Name Cate-gory Indications Dosage Coal Tar 1-9% Ointment B Dandruff, seborrhoeic dermatitis, atopic dermatitis, eczema and psoriasis. Used as a mild astringent for the skin, as a soothing and protective application in eczema and as a protective to slight excoriation Apply sparingly to the affected area 1-3 times daily starting with low strength preparations Coal Tar 20% Solution B Dandruff, seborrhoeic dermatitis, atopic dermatitis, eczema and psoriasis Use 100 ml in a bath	-
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]