Why is this trusted mainstay treatment disappearing from pharmacy shelves?
On a recent visit to dermatology clinic I met Michael, a 37 year old teacher from Carlow, who had come in ask some advice; he was looking for an alternative to the coal tar pomade he usually gets from his pharmacist every few weeks.
“I just wanted to see if there is any information about coal tar; it’s been the main way I manage my scalp psoriasis treatment for the past 15 years but I can’t seem get it. I have been in touch with my GP and local pharmacists – they all say that it is not being made anymore. I am sure there are many other people who rely on coal tar products to treat psoriasis”, he explained.
Hundreds affected by disappearance of coal tar products
The Irish Skin Foundation has had dozens of enquiries about the disappearance of coal tar pomade. It appears that hundreds of people are affected. Where coal tar is stocked by pharmacies, it seems to have increased in price enormously (often by a factor of ten). The shortage is also driving people to sourcing coal tar at hugely inflated prices online.
“Sourcing coal tar is also a hot topic on internet forums and social media. People feel they have been left high and dry by the sudden disappearance of a trusted treatment. This is clearly having a negative impact on quality among people already in discomfort and who may have low confidence about caused by psoriasis or eczema”, according to Cáit Donnelly, website and social media manager for the ISF.
What is coal tar?
Coal tar is a by-product of the industrial process that turns coal into coke. It is used in dozens of over-the-counter products and has been a mainstay treatment of people with psoriasis, eczema and other skin conditions for decades.Coal tar, a thick brown substance, reduces itchiness and inflammation. In Michael’s case it was prepared into a cream/pomade (either by a pharmaceutical company or a pharmacist who makes extemporaneous preparations ) for application to the skin. Coal tar can be found in skin creams, bath oils and shampoos used to treat eczema and psoriasis. It is thought that it reduces or slows the production of DNA, thereby slowing the production of new cells and calming flare-ups.
So why are coal tar products disappearing?
We asked a number of pharmaceutical companies why they have discontinued production of the coal tar products. Two companies said they unable to source the active ingredient (coal tar) from their approved supplier while another said coal tar had become prohibitively expensive.
One former manufacturer said that “due to the revised requirements effecting the classification, labelling and packaging of coal tar under REACH regulations the traditional sources of coal tar used are no longer in a position to provide a cost effective supply of the raw material”. Yet the Health and Safety Authority (HSA), which is responsible for REACH and Classification, Labelling and Packaging (CPL), says that coal tar is subject to the same requirements as any other substance coming into the EU.
The Health Products Medical Authority (HPRA), which licenses medical products in Ireland, says that coal tar is the active ingredient in a number of licensed medicinal products in Ireland and that there were no safety concerns around the use of coal tar in regulated medication.
Of course, suggestions have been made that that commercial profitability is a factor. Newer remedies which contain steroids and vitamin D cost four or five times as much as coal tar pomade. However, manufacturers and specialist compounding facilities that make no competing products are also discontinuing coal tar pomade.
As a result dermatologists fear that people with mild or moderate psoriasis or eczema, and who can’t source coal tar pomade, may have to use stronger medications like topical steroid creams, that have side-effects such as thinning the skin.
Michael’s own opinion is simple. “I’ve used it for years, it’s far from perfect but it was reliable, cheap and it works. Not being able to get it in my local pharmacy was annoying but if coal tar disappears altogether the main way I’ve gotten used to managing with psoriasis will be gone; that’s a big problem for me.”
Update December 2015: The ISF has been contacted by several people who buy coal tar based products in Northern Ireland who recommend asking pharmacists whether their shop stocks the particular product they wish to buy (coal tar products are often stored behind counters with prescription drugs etc.). The ISF understands anecdotally that availability of a number of coal tar products is greater in Northern Ireland and that the products themselves may be priced considerably lower than in the Republic of Ireland.