Anthralin (Topical)

Anthralin (AN-thrah-lin) is a topical medication widely used to treat long-term psoriasis, and is an alternative treatment for hair loss in patients with alopecia areata.

Overview

Anthralin is a man-made, tar-like substance used to treat chronic psoriasis. This is a condition characterized by scaling and drying of the skin due to the overgrowth of skin cells. In the U.S., this medicine is available only by prescription.

As an antimitotic, anthralin works by slowing down the overgrowth of skin cells in psoriasis patients. Side effects are generally mild.

Anthralin is also one of the medications used to treat the scalp of patients with alopecia areata. The condition causes patients to lose patches of hair. Although not approved by the Food and Drug Administration (FDA) for this purpose, the use of anthralin results in hair regrowth. It works through contact immunotherapy, triggering an allergic reaction that stimulates regrowth.

The medicine comes in the form of a cream, ointment, paste or shampoo, and is sold under other brand names, such as Drithocreme. A variety of strengths, usually 0.1 to 1%, are available. Dosage varies based on the condition treated and the patient's tolerance of the therapy. It is not recommended for use in children, older adults, and pregnant or breastfeeding women.

Conditions treated

Type of medicine

  • Antimitotic

Side effects

As with any medicine, there are side effects of using anthralin for treating psoriasis and alopecia areata. Anthralin has been found to cause tumors in animals, but there is no reported case of anthralin causing tumors in humans.

The known side effects are generally mild, but some patients experienced severe reactions requiring emergency care. Some staining of clothing, and discoloration of hair, skin, and fingernails may occur upon contact with the medicine.

Treatment of psoriasis

The most common side effects are:

  • Redness or irritation: This is a commonly reported side effect affecting the skin where the medication was applied.
  • Rash or soreness: Patients complained of developing a rash or soreness of the skin where the medicine was applied.

These side effects are generally mild and go away on their own. If they persist or worsen, patients are advised to call their doctor or pharmacist. You should tell your doctor right away if there is increased soreness of the skin or spreading of the psoriasis.

A serious allergic reaction due to the use of anthralin is rare. Some patients experienced itching and hives, tightness in the chest, or swelling of the face, lips and tongue. If these occur, patients are advised to call their doctor or seek urgent medical care.

To prevent allergic reactions, patients should tell their health care professional of any known allergies to foods, dyes, preservatives, or animals. This is especially important as the medication may have inactive ingredients that can trigger allergic reactions.

Treatment of alopecia areata

Alopecia areata is treated by applying anthralin paste or ointment directly to the affected scalp for a period of time, before washing off. Most patients develop contact skin irritation and a rash. Severe irritation, inflammation of hair follicles, and swollen lymph nodes may also occur.

Patients should notify their doctor immediately if these side effects occur. The doctor may advise to withhold treatment for a few days, then continue by applying the medicine for shorter periods.

Dosage

Anthralin (cream, ointment, paste, and shampoo) is for external use only. It is applied to the skin or scalp as directed by a doctor or pharmacist. Dosage varies from patient to patient and may be used for long contact or short contact therapy. The higher the concentration, the higher the chance for contact irritation.

With short contact therapy, anthralin is applied directly to the affected skin or scalp for approximately 10 to 30 minutes. It is then washed off by shampooing the treated area. For longer therapy, the medication is applied at night and washed off the following morning.

The number of doses taken each day, the length of time between doses, and the overall duration the medicine is taken depend on the condition treated. The patient's tolerance of the medicine is also a factor considered.

Using anthralin as directed may reduce the chance of side effects and increase the chance of results. Allow it to sit on the treated skin only for the prescribed contact time.

Treatment of psoriasis

Anthralin cream, adults: Following the prescription label or directions of a healthcare professional, apply the recommended amount directly to the affected skin, once a day (usually), preferably at night. Wash the medication off at the end of the contact time, usually in the morning.

For short contact therapy, apply as directed to the dry, affected skin, once a day. Wash medication off at the end of the contact time, usually 10-30 minutes.

Wear protective gloves to apply and a hair cap overnight to prevent unnecessary contact irritation, staining, and discoloration.

Anthralin ointment, adults: Apply the recommended amount directly to the dry, affected skin once a day or as directed by a doctor. Wash the medicine off at the end of the contact time.

The scalp may be treated as directed using either anthralin cream or ointment. Using short contact therapy, it is applied to the affected area of the scalp using 1% strength or higher.

Use anthralin shampoo by wetting the hair, then applying and massaging thoroughly onto the scalp. Work into a lather and leave on the scalp for 3 to 5 minutes, taking great care to avoid contact with the eyes. Rinse thoroughly with lukewarm water. Repeat 3 to 4 times a week, or as directed by a doctor.

Anthralin, in any form, is not recommended for use in children, geriatrics, and pregnant or breastfeeding women, unless determined by a doctor.

Treatment of alopecia areata

Prescription anthralin is also used to treat alopecia areata through the process of topical immunotherapy, also known as 'contact therapy'. Both short-contact and overnight treatments are used.

As prescribed, apply daily for 15-20 minutes and then wash off. The contact time is increased by 5 minutes weekly, up to 1 hour, or until low-grade dermatitis develops. The contact time is then fixed and continued daily for at least 3 months, before assessing the response to treatment.

Missed dose and overdose

If you miss a dose of this medicine, apply it as soon as possible. If the next dosage time is close, skip the missed dose and go back to your regular dosing schedule. In case of accidental overdose or swallowing, call 911 or the poison control center at 800-222-1222.

Interactions

Prescription, and even over-the-counter (OTC) drugs, may interact with each other when taken or used. Tell your doctor or pharmacist about all your drugs, herbal products, vitamins, and health problems. This will help in determining whether it is safe for you to take anthralin.

There is no known list of foods or drugs that interact with anthralin. This does not mean no interactions exist. Discuss the use of alcohol, food, and tobacco with your doctor as they may affect the way the medicine works. Read all instructions to avoid using any food or drug that may adversely interact with the medicine.

Warnings

Drugs and medications are designed to be used strictly according to directions. Follow all directions to achieve maximum relief when using anthralin. If contact irritation of normal skin occurs, apply petroleum jelly to affected areas for relief.

Discuss your medical history and current health problems, especially kidney disease, with your doctor. Anthralin may have inactive ingredients that can trigger allergic reactions. Tell your doctor of any allergies, OTC or herbal medications you take. Mention skin products or shampoos already being used for treatment.

Consult a doctor or pharmacist before you start, stop, or change the dose of anthralin in any form. This external-use medication should be applied directly to the affected areas to avoid exposing uninvolved skin. Avoid contact with the eyes, nose, ears, and mouth and wash hands immediately after each application.

Anthralin is not recommended to be applied on:

  • Acutely inflamed psoriasis
  • Blistered, raw, or oozing areas of skin or scalp
  • Sex organs
  • Facial skin
  • Folds or creases of skin

Alopecia patients should take special care to avoid anthralin contact with the eyes during application to the scalp. Severe conjunctivitis may occur if this happens. Remove any residue that comes into contact with the ears. During treatment, protect the treated scalp from exposure to the sun.

Use the medicine only to treat the condition it was prescribed for, unless otherwise directed by a doctor or pharmacist. Leave on the medication only for the required contact time. Rinse off immediately after. If irritation occurs or your condition worsens, discontinue use and call your doctor. Call 911, your doctor or the poison control center at 800-222-1222 if it is accidentally swallowed.

Anthralin is not recommended for use in children, older adults, and pregnant or breastfeeding women. Seek a doctor's advice.

Keep out of the reach of children.

Storage

Anthralin should be stored at room temperature between 59-86 degrees F (15-30 degrees C). Protect from freezing. It should not be stored in the bathroom and must be kept in the container, tightly closed and away from heat, light, children, and pets.

Any remaining medicine should be disposed of according to the label instructions, or as directed by a doctor. Avoid flushing the medication down the toilet or pouring it into a drain, unless instructed to do so. A healthcare professional or local waste disposal company can provide additional details on how to safely dispose of it.

Summary

Anthralin proves to be an effective way to treat psoriasis. Functioning as a mitotic inhibitor, it checks the overgrowth of skin cells. The drug is designed for external use only on affected areas of the skin and scalp. It is easy to use, store, and discard by following simple directions.

The medication can be purchased in the US only by prescription due to its potency and ability to easily irritate skin, eyes and other body parts.

Positive results are generally seen once the medicine is used with special attention to precautions and warnings. Despite some mostly mild and rare side effects, anthralin therapy is still the recommended way to treat long-term psoriasis. Whenever severe side effects or severe allergic reactions occur, urgent medical care is usually required.

Even though the FDA did not approve anthralin immunotherapy to treat hair loss in alopecia patients, the use of the medicine has helped with hair restoration. Regardless of its potential to cause swollen lymph nodes and inflammation of hair follicles, the medicine continues to be a popular treatment.

Until its safety and efficacy are established, the use of anthralin in children, pregnant or breastfeeding women, and geriatrics remains restricted.

Anthralin therapy may require patients to endure some amount of discomfort. It is therefore important for patients to determine whether the benefits of the medication outweigh the side effects.

Resources
Last Reviewed:
December 22, 2017
Last Updated:
April 04, 2018