Coal Tar and Dithranol for Psoriasis: How They Work and When They're Used
How coal tar and dithranol treat psoriasis, their downsides, and how they compare with newer treatments.
Part of our psoriasis guide.
Get urgent help first. Call 999 or go to A&E if your skin suddenly becomes red and inflamed over most of your body, or you have widespread pus-filled spots, especially with a fever, chills or feeling very unwell. These can be signs of erythrodermic or generalised pustular psoriasis, which are emergencies. See a GP soon if you have painful, swollen joints. Online treatment isn't suitable in these situations.
Key fact: coal tar reduces scaling and inflammation and is an option in NICE's third treatment step, when vitamin D hasn't controlled psoriasis. Dithranol works well on thick plaques but stains heavily, and is now used mainly in hospital.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor's online psoriasis service is for adults aged 18 and over, and can't supply treatment if you're pregnant or breastfeeding: your GP or midwife can help. Children with psoriasis should see their GP.
Coal tar for psoriasis
Coal tar has been used to treat psoriasis for more than 100 years. It reduces inflammation, slows skin cell growth and helps loosen scale. It comes as creams, lotions, ointments, shampoos and bath additives, in different strengths. In NICE's treatment steps for plaque psoriasis, coal tar is an option at the third step, if vitamin D hasn't controlled the psoriasis, and it can be used during breaks between steroid courses.
Exorex lotion
Exorex lotion contains 5% coal tar solution and is licensed for psoriasis of the skin and scalp. Adults apply a thin layer 2 to 3 times a day. It's less messy than older tar ointments but still has a tar smell.
Downsides of coal tar
- A strong smell, which some people find hard to live with.
- Staining of skin, hair, clothes and bedding.
- Irritation or inflamed hair follicles (folliculitis).
- Increased sensitivity to sunlight: avoid sunbathing after applying it.
- Not suitable for inflamed, broken or infected skin, or the face, genitals and skin folds unless a doctor advises.
Dithranol for psoriasis
Dithranol is one of the oldest psoriasis treatments and can be very effective for thick, stubborn plaques. It's usually used as short-contact therapy: applied to the plaques for a short time, often 15 to 30 minutes, then washed off, with the time increased gradually.
- It stains skin (temporarily brown or purple), hair, clothes, baths and showers.
- It burns and irritates normal skin, so it must be applied to plaques only.
- It isn't used on the face, skin folds, genitals or inflamed, spreading psoriasis.
Dithrocream has been discontinued. The main UK dithranol cream for home use was discontinued in 2021 and 2022, so dithranol is now mainly made up and used in hospital dermatology day-treatment units. Ask your GP about a referral if you think it might help.
Coal tar vs dithranol vs newer treatments
| Coal tar | Dithranol | Steroid + vitamin D | |
|---|---|---|---|
| How well it works | Moderate | Good for thick plaques | Good; usually the first choice |
| Mess and staining | Smell and staining | Heavy staining | Minimal |
| Where it's used | At home | Mostly hospital units now | At home |
| Long-term use | Yes | Courses | Courses, with breaks |
For most people, a steroid combined with vitamin D, such as Enstilar or Dovobet, works faster and is easier to use. Coal tar remains a useful option, especially for the scalp and during steroid breaks. See our treatment options guide and our guide to calcipotriol.
Coal tar shampoos
Coal tar shampoos are widely used for scalp psoriasis and dandruff. Scalp treatments are covered on our scalp psoriasis treatment page.
Coal tar at Access Doctor: coal tar products for body psoriasis aren't yet available through our online service. We supply steroids and steroid with vitamin D combinations for diagnosed plaque psoriasis.
Looking for a psoriasis treatment that's easier to use?
Our GPhC-registered pharmacist independent prescribers can assess your psoriasis online and, if suitable, prescribe a steroid or a steroid with vitamin D. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Psoriasis Consultation →How our online service supplies psoriasis treatment: adults 18 and over, not for the face, genitals or skin folds. Enstilar, Dovobet and other psoriasis-only treatments need psoriasis already diagnosed by a GP or dermatologist. Enstilar and Dovobet: one pack per order, supplied as a course of up to 4 weeks, on no more than 30% of the body. Betnovate and Elocon: up to 3 × 30g or 1 × 100g, for a 4-week course followed by a 4-week break. Dermovate only if you have been prescribed it before. Widespread psoriasis, joint pain or psoriasis that hasn't responded to treatment is referred to your GP.
UK safety and reporting side effects
Prescription psoriasis treatments are only supplied after a GPhC-registered pharmacist independent prescriber reviews your consultation, including where your psoriasis is, how much skin it covers and what you have used before. Always read the patient information leaflet. Since 2024, UK steroid packs show their strength on the front (mild, moderate, strong or very strong). The MHRA advises using topical steroids for the shortest time needed, and to tell a healthcare professional if your skin flares badly after you stop a steroid you have used for a long time, which can be a topical steroid withdrawal reaction.
If you think you've had a side effect, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme.
Psoriasis treatments from Access Doctor
Following an online consultation, our prescribers can supply the treatments below where suitable, as part of our psoriasis treatment service.
Vitamin D + potent steroid · Rx
Enstilar Foam
Calcipotriol with betamethasone in a spray foam, once a day for up to 4 weeks. For diagnosed plaque psoriasis.
View product →Vitamin D + potent steroid · Rx
Dovobet Gel
Calcipotriol with betamethasone, for the scalp and for mild to moderate plaque psoriasis on the body.
View product →Potent steroid · Rx
Betnovate Ointment
The greasier form, better for thick, dry or scaly plaques.
View product →Potent steroid · Rx
Elocon Ointment
Once-daily mometasone in an ointment base, for dry, thick plaques.
View product →Frequently Asked Questions
Can coal tar be used to treat psoriasis?
Yes. Coal tar reduces inflammation and scaling and is an option in NICE's treatment steps for plaque psoriasis if vitamin D hasn't controlled it. It can also be used during breaks between steroid courses.
What is dithranol ointment used for?
Dithranol is used for thick, stubborn plaque psoriasis, usually as short-contact therapy: applied for a short time, then washed off. It stains skin and clothes, and is now mainly used in hospital dermatology units.
Is Dithrocream still available?
No. Dithrocream was discontinued in the UK between 2021 and 2022. Dithranol is now mainly made up and used in hospital day-treatment units.
What is the strongest ointment for psoriasis?
The strongest topical steroid is clobetasol (Dermovate), used for short courses. Dithranol is also very effective for thick plaques. For most people, a steroid with vitamin D, such as Enstilar or Dovobet, is the most effective first choice.
Is coal tar or salicylic acid better for psoriasis?
They do different jobs. Salicylic acid mainly loosens scale, while coal tar reduces inflammation as well as scale. They're sometimes combined, and salicylic acid can help other treatments get through thick scale.
References
- NICE. Psoriasis: assessment and management (CG153). nice.org.uk
- Coal Tar (Exorex) Lotion: summary of product characteristics. medicines.org.uk
- Joint Formulary Committee. British National Formulary: psoriasis (treatment summary). bnf.nice.org.uk
- Pharmacy Magazine. Dithrocream discontinued over supply chain issues. June 2021. pharmacymagazine.co.uk
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk
Medical disclaimer: This article is for information only and isn’t medical advice. Prescription psoriasis treatments need a clinical consultation before they can be supplied. If your skin is red all over, you have widespread pus spots, a fever or you feel unwell, seek medical advice the same day. In a medical emergency, call 999.