coal tar solution + precipitated sulfur + salicylic acid: clinical use

Prescribing considerations

• Confirm that scaling is covered by the scalp indication rather than infection or acute pustular psoriasis.
• Children aged 6 to 12 years require medical supervision; use below 6 years is not recommended.
• Counsel about ocular and mucosal avoidance, staining and the fabric fire hazard.
• Cetostearyl alcohol may cause local contact dermatitis.

Contraindications and cautions

• Hypersensitivity to an active ingredient, salicylates or an excipient
• Acute local skin infection
• Acute pustular psoriasis
• Inflamed or broken skin
• Third trimester of pregnancy

Monitoring

• Assess local irritation, dermatitis, folliculitis and hypersensitivity.
• Review persistent or worsening symptoms and reconsider the diagnosis, adherence and need for alternative treatment.
• Ask about asthma or familial salicylate hypersensitivity if respiratory symptoms occur.

Clinical pharmacology

Coal tar is antipruritic and keratoplastic with weak antiseptic activity. Salicylic acid is keratolytic. Precipitated sulfur is keratolytic with weak antiseptic and antiparasitic actions. Product-specific pharmacokinetic data are unavailable.

Formulation and product differences

• The UK product is a topical scalp ointment rather than a shampoo.
• Its paraffin-containing base presents a fabric fire hazard.
• The formulation contains coconut oil and cetostearyl alcohol.