Betamethasone dipropionate 0.05% ointment 25% / Coal tar solution strong 3% / Salicylic acid 2% in Generic Unguentum M cream

BACKGROUND: Chronic plaque psoriasis is the most common type of psoriasis and is characterised by redness, thickness and scaling. First line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid and topical retinoids. OBJECTIVES: To compare the effectiveness, tolerability and safety of topical treatments for chronic plaque psoriasis with placebo; to compare vitamin D analogues with other topical treatments. SEARCH STRATEGY: The Cochrane Skin Group's Trials Register was searched (2004/12). To update an unpublished 2002 review we also searched CENTRAL in The Cochrane Library (Issue 1,2005); MEDLINE (to 2005/02); EMBASE (to 2005/08); Science Citation Index (to 2005); Biosis (to 2005); Dissertation Abstracts (all publication years); Inside Conferences (all publication years); SIGLE (to 2005); National Research Register (all projects with a start date of 2001 to 2005); metaRegister of Current Controlled Trials. SELECTION CRITERIA: Randomised trials comparing treatments against placebo or against vitamin D analogues in people with chronic plaque psoriasis. DATA COLLECTION AND ANALYSIS: One author extracted study data and assessed study quality. A second author checked these data. We routinely contacted triallists and companies for missing data. We extracted data on withdrawals and adverse events. MAIN RESULTS: The review included 131 RCTs with 21,448 participants. Vitamin D was significantly more effective than placebo, although there was a wide variation in effect size with the standardised mean difference (SMD) ranging from -0.82 (95% CI -1.34 to -0.29) to -1.90 (95% CI -2.09 to -1.71). With one exception, all corticosteroids performed better than placebo, with potent corticosteroids (SMD: -0.95 (95% CI: -1.11 to -0.80; I(2): 61.1%; 17 studies; 2386 participants)) having smaller benefits than very potent corticosteroids (SMD: -1.29 (95% CI: -1.45 to -1.13; I(2): 53.2%; 11 studies; 1571 participants)). Dithranol and tazarotene performed better than placebo. Head-to-head comparisons of vitamin D against potent or very potent corticosteroids found no significant differences. However, combined treatment with vitamin D /corticosteroid performed significantly better than either vitamin D alone or corticosteroid alone. Vitamin D performed better than coal tar, but findings relative to dithranol were mixed. Potent corticosteroids were less likely than vitamin D to cause local adverse events. No comparison of topical agents found a significant difference in systemic adverse effects. AUTHORS' CONCLUSIONS: Corticosteroids perform as well as vitamin D analogues and are associated with a lower incidence of local adverse events. Further research is required to inform long-term maintenance treatment.

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Topical therapy as monotherapy is useful in psoriasis patients with mild disease. Topical agents are also used as adjuvant for moderate-to-severe disease who are being concurrently treated with either ultraviolet light or systemic medications. Emollients are useful adjuncts to the treatment of psoriasis. Use of older topical agents such as anthralin and coal tar has declined over the years. However, they are cheaper and can still be used for the treatment of difficult psoriasis refractory to conventional treatment. Salicylic acid can be used in combination with other topical therapies such as topical corticosteroids (TCS) and calcineurin inhibitors for the treatment of thick limited plaques to increase the absorption of the latter into the psoriatic plaques. Low- to mid-potent TCS are used in facial/flexural psoriasis and high potent over palmoplantar/thick psoriasis lesions. The addition of noncorticosteroid treatment can also facilitate the avoidance of long-term daily TCS. Tacrolimus and pimecrolimus can be used for the treatment of facial and intertriginous psoriasis. Tazarotene is indicated for stable plaque psoriasis usually in combination with other therapies such as TCS. Vitamin D analogs alone in combination with TCS are useful in stable plaques over limbs and palmoplantar psoriasis. Topical therapies for scalp psoriasis include TCS, Vitamin D analogs, salicylic acid, coal tar, and anthralin in various formulations such as solutions, foams, and shampoos. TCS, vitamin D analogs, and tazarotene can be used in the treatment of nail psoriasis.

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Abstract Phenanthrene, a common three-ring polyaromatic hydrocarbon [PAH], originates from sources like grilled meals, tobacco, crude oil, coal tar, and automobile exhaust. Recognized as a hazardous PAH, it is often targeted for bioremediation due to its sustainability and potential for full mineralization. In this study, we focus on biodegrading phenanthrene using the strain Alcaligenes ammonioxydans [VITRPS2], isolated from petroleum-contaminated soil. At 5 mg/ml, degradation occurred at a rate constant of 0.0181/day, with half-life values of 2.7 and 4.49 according to first and second-order kinetics, respectively. Employing a one-factor-at-a-time [OFAT] approach, we optimized biodegradation conditions within Luria–Bertani [LB] media. Under optimal conditions—pH 8.0, 8% inoculum concentration, and 37 °C incubation over seven days—the strain achieved maximal growth with phenanthrene as the sole carbon source. It exhibited a degradation efficiency of up to 72% for phenanthrene under these conditions. Gas chromatography-mass spectrometry [GC–MS] analysis revealed principal metabolites of the breakdown pathway, including salicylic acid, catechol, and various phthalic acid derivatives. This underscores the strain's potential for remediating environments polluted by PAH metabolites, showcasing its remarkable capability for complete phenanthrene degradation. Graphical abstract

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More as a decade before aniline and phenol were isolated from coal tar by Runge in 1834 and used for the fabrication of a number of important dyes, such as Aniline Black, Mauveine, and Fuchsine, the German naturalist von Reichenberg observed the formation of a red dye from beech tar, which he called pittakal. In this report, both the history of discovery and the laborious structure elucidation of this first tar dye were discussed and the subsequent efforts to obtain further usable dyes from phenol outlined. A decisive contribution for that came from Kolbe and Schmitt, who better known as the inventors of the first technical synthesis of salicylic acid.

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Superficial dermatophytic infections in the present scenario require a prolonged antifungal therapy due to chronicity and high recurrence. The rampant misuse of topical agents such as topical steroids, dithranol, coal tar, and salicylic acid, designed for different dermatological conditions, has led to the present disaster. Awareness of avoidance of self-medication along with an early diagnosis, discontinuation of the topical agent, and proper antifungal therapy is a dire need of today. We report seven cases of superficial dermatophytosis modified by the application of the fixed drug combination containing dithranol, salicylic acid, and coal tar.

Abstract licence: CC BY-NC-SA

Background: Patients with mild psoriasis are generally treated with topical medications including corticosteroids, coal tar, anthralin (Dithranol), salicylic acid, vitamin D analogues such as calcipotriol, retinoid such as tazarotene, and calcineurin inhibitors such as pimecrolimus. The most commonly used safe systemic non-biological medications include methotrexate which has been used as early as the 1960s, mycophenolate mofetil which has been used as early as the 1970s, and acitretin which has been used as early as the 1980s. Safe systemic biological medications include infliximab which has been used as early as 2001. Patients and methods: The case of a 51-year-old diabetic and hypertensive male who had moderately severe psoriasis with history of arthritic symptoms is described. Results: The patient had been treated with several topical medications for years; however, the steroid containing topical therapies have been recently linked with worsening of hyperglycemia. Therefore, topical treatment was replaced with oral methotrexate 5 mg twice weekly. After few weeks of methotrexate treatment, there was slight improvement, and therefore increasing the dose of methotrexate to 7.5 mg twice weekly was suggested by the earlier treating physician, however, the patient was reluctant to increase the dose methotrexate because he has already aware of the possible hepatotoxic effect. When the patient presented to us, he had significant area of his body affected and systemic treatment was considered necessary. The decision was made to add oral mycophenolate with attempt of gradually withdrawing methotrexate. According to the published experiences with the use of mycophenolate monotherapy in psoriasis, a satisfactory response is expected to occur in about 70% or less, and therefore the decision was made add topical calcipotriol 0.005% and give once daily at night. Conclusion: The current evidence-based expert opinion suggests that the choice of the treatment of methotrexate resistant psoriasis depends to a large extent on the availability of the medication, and the experience of the treating physician with the available medications. Mycophenolate can be used safely with beneficial effect in severe psoriasis and methotrexate psoriasis.

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Alopecia areata (AA) is an autoimmune disorder characterized by patchy, non-scarring hair loss. Anthralin (dithranol) is a topical irritant that has shown efficacy in treating AA. Despite its therapeutic potential, there is a common belief that combining steroids with dithranol may reduce its effectiveness. This report presents a case of alopecia totalis in which a combination of systemic steroids and dithranol was used with a synergistic therapeutic effect. A 12-year-old boy with a six-month history of complete scalp hair loss was diagnosed with alopecia totalis. He was treated with betamethasone pulse therapy and Derobin TM ointment (a combination of coal tar, salicylic acid, and dithranol) and applied to both halves of the scalp on a rotational basis. The patient misunderstood the instructions, applying the ointment only to one side while taking systemic steroids. After 2 months, hair regrowth was observed exclusively on the treated side, demonstrating the potential synergistic effect of the combined treatment. Anthralin promotes hair regrowth by inhibiting pro-inflammatory cytokines, while steroids also reduce these cytokines, suggesting a possible synergistic effect. Our case highlights that combining systemic steroids with dithranol can reduce irritation, improve compliance, and enhance hair regrowth. The findings suggest that this combination could be effective for managing severe AA with minimal side effects. The combination of dithranol and systemic steroids may offer a promising approach to treating alopecia areata, enhancing regrowth while minimizing irritation.

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Psoriasis, a chronic inflammatory skin disorder, presents a therapeutic challenge due to its diverse manifestations and impact on patients' lives. This review delves into the intricacies of topical agents used in managing psoriasis, encompassing corticosteroids, vitamin D analogs, retinoids, calcineurin inhibitors, and unconventional treatments like coal tar and salicylic acid. Each agent's potency, application, and considerations for different age groups are discussed, providing clinicians with a comprehensive guide for treatment selection. The multifaceted nature of psoriasis requires tailored approaches, and understanding the nuances of these topical therapies is crucial for optimizing outcomes. Ongoing research promises further advancements in psoriasis management, holding potential for more personalized and effective interventions.

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