Salicylic Acid, Sulfur, and Coal Tar (Topical)

As a topical cream, the combination treatment of Salicylic acid, sulfur and coal tar is an effective treatment for seborrheic dermatitis, psoriasis, and dandruff.

Overview

Salicylic acid, sulfur, and coal tar are often combined in the form of a topical cream or shampoo, and marketed under the brand names Pazol XS and Ala-Seb-T as a means to treat dandruff and psoriasis and to control seborrheic dermatitis. Other active and inactive ingredients often used in conjunction with salicylic acid, sulfur and coal tar include emulsifying wax, coconut oil, polysorbate, liquid paraffin and white soft paraffin.

On its own, salicylic acid functions to remove the outside layer of the epidermis. It is therefore considered useful in the treatment of psoriasis, dandruff, acne, warts, ringworm, and ichthyosis.

Sulfur is a naturally occurring chemical element and has been used in medicine for centuries. Its earliest documented use dates back to 6th century China. It is useful for its ability to treat allergies and pain syndromes.

Coal tar is a thick, dark liquid which alleviates itching, scaling and flaking, and belongs to a group of medicines known as keratoplastics. It functions by causing the skin to shed excess dead cells from the top layer while slowing the growth of skin cells. Excess cell growth is associated with some irritant skin conditions, and coal tar is therefore useful in restoring the natural appearance of the epidermis.

Conditions Treated

  • Psoriasis
  • Dandruff
  • Seborrheic dermatitis
  • Eczema

Type of Medicine

  • Combined keratolytic agent

 

Side Effects

Along with its required effects, the combined treatment of salicylic acid, sulfur, and coal tar can also cause certain unwanted side effects. The most common effects reported by patients undergoing treatment with this medication include itching, irritation, and redness of the skin.

As the patient continues to use this medication as prescribed, some (if not all) of the previously mentioned side effects should lessen. If side effects persist or appear to get worse over time, the patient is advised to inform their doctor as soon as possible. A doctor or healthcare provider may be able to advise a patient on how to alleviate uncomfortable side effects with natural or over the counter medicines.

Dosage

As with all medications, it is vital that patients use salicylic acid, sulfur and coal tar as prescribed by a qualified doctor. This means that healthcare professionals should avoid administering more of this medicine than is advised, either in dose size or frequency. In addition to this, clinicians should discontinue use of this medication on a patient if a doctor says so, even if they have a supply of the medicine remaining.

While the manufacturers of salicylic acid, sulfur, and coal tar provide general dosage instructions, it should be reiterated that these are simply recommendations and are likely to be altered by the patient’s doctor. Numerous factors will influence dosage amounts, including the skin condition of the patient’s scalp prior to treatment.

This medicine is best taken by following the application instructions included in the literature the product is shipped with:

  • Do not take this medicine orally, It should be used on the skin only, and kept away from the eyes, nose or mouth as it may cause a burning sensation.
  • Salicylic acid, sulfur, and coal tar should be used only as advised by a qualified healthcare professional.
  • Avoid applying this cream or shampoo to healthy areas of the skin.
  • Do not cover affected areas with dressings, bandages or makeup after use unless expressly told to by a doctor.
  • Ensure that hands are washed thoroughly before and after use.
  • Shake the product within its container before use, as some ingredients may settle during storage.
  • Wet the scalp and hair.
  • Apply cream or shampoo, lathering well.
  • Leave product on hair and scalp for five minutes.
  • Rinse product from head.
  • Re-apply, lather and leave on for a further five minutes.
  • Rinse and dry the hair and scalp area.

If a patient misses a dose, they should apply the missed dose as soon as they can. If it is too close to the time for the next dose, the missed dose should be skipped, with the patient resuming normal dosage from the following dose onwards. Patients should avoid using extra doses or quantities to make up for the missed dose as this can increase the potential for side effects such as irritated skin to occur.

Although the propensity for overdose using this medication is low to the point of being non-existent, using too much of the cream or shampoo can cause an uncomfortable reaction in the skin resulting in swollen, blistered, peeling skin, a rash, hives, unusual hoarseness, trouble breathing or talking, tightness in the throat or chest, and swelling of the mouth, face, lips, throat and tongue. If a patient thinks they may have overdosed on this medicine, they are advised to contact their local poison control center as soon as possible or to call the emergency services on 911. Patients in this situation should be prepared to show or tell what medicine was taken, how much was applied and what happened as a result.

Interactions

All medicines have the potential to interact with other medicines or chemicals within the human body. In some instances, this can cause a medicine to become ineffective. In other circumstances, these interactions can cause serious side effects to occur. Because of this possibility, patients are advised to keep a detailed list of all drugs they are currently undergoing treatment with. This extends to complementary medicines, herbal supplements, vitamins and over-the-counter remedies.

Below is a partial list of medicines known to interact negatively with salicylic acid, sulfur, and coal tar. Patients who are currently taking any of these medications should inform their doctor prior to beginning treatment with this medicine:

  • Absorica (isotretinoin)
  • Accutane (isotretinoin)
  • Alitretinoin topical
  • Altinac (tretinoin topical)
  • Ameluz (aminolevulinic acid topical)
  • Aminolevulinic acid topical
  • Amnesteem (isotretinoin)
  • Atralin (tretinoin topical)
  • Avage (tazarotene topical)
  • Avita (tretinoin topical)
  • Claravis (isotretinoin)
  • Clindamycin/tretinoin topical
  • Fabior (tazarotene topical)
  • Fluocinolone / hydroquinone / tretinoin topical
  • Isotretinoin
  • Levulan Kerastick (aminolevulinic acid topical)
  • Mequinol/tretinoin topical
  • Methyl aminolevulinate topical
  • Metvixia (methyl aminolevulinate topical)
  • Myorisan (isotretinoin)
  • Obagi (tretinoin topical)
  • Panretin (alitretinoin topical)
  • Refissa (tretinoin topical)
  • Renova (tretinoin topical)
  • Retin A Micro (tretinoin topical)
  • Retin-A (tretinoin topical)
  • Retin-A and Renova (tretinoin topical)
  • Retisol-A (tretinoin topical)
  • Solage (mequinol / tretinoin topical)
  • Sotret (isotretinoin)
  • Stieva-A (tretinoin topical)
  • Stieva-A Forte (tretinoin topical)
  • Tazarotene topical
  • Tazorac (tazarotene topical)
  • Tretin-X (tretinoin topical)
  • Tretinoin topical
  • Tri-Luma (fluocinolone / hydroquinone / tretinoin topical)
  • Veltin (clindamycin/tretinoin topical)
  • Vitinoin (tretinoin topical)
  • Zenatane (isotretinoin)
  • Ziana (clindamycin/tretinoin topical)

Warnings

Before using salicylic acid, sulfur and coal tar combined cream or shampoo, patients should inform their doctor if:

  • They have an allergy to salicylic acid, sulfur, and coal tar, or any of the other ingredients used in this topical treatment.
  • They are allergic to any other drugs similar to this one. Patients with allergies should inform their doctor about the nature of the allergy and what symptoms the patient experiences as a result, for example, shortness of breath, itching, coughing, rash, hives, or any other signs.
  • If they suffer from any of the following conditions: kidney disease, low blood sugar (diabetes), skin infection/irritation, poor blood flow or liver disease.

In addition to these precautions, patients should be aware of the following information prior to using salicylic acid, sulfur, and coal tar:

  • This product should not be used on cuts, open wounds or particularly irritated skin.
  • This product should not be used on moles, birthmarks or warts with hair growth. It should only be used on the scalp and is not suitable for the treatment of cervical, genital or oral warts.
  • Combining other skin products with this medicine could result in more irritation.
  • Patients undergoing treatment with salicylic acid, sulfur, and coal tar may find that their skin is more sensitive to sunlight, resulting in them getting burned more easily. Patients should, therefore, avoid direct sunlight, sunlamps and/or tanning beds while using this product.
  • This product could potentially stain hair, skin, and fingernails.
  • Children or teenagers who are suffering from or recovering from influenza, chickenpox or other viral infections should avoid using this medicine, as it may induce Reye’s syndrome. Reye’s causes serious problems to the liver and brain.
  • Women who are pregnant or intending to become pregnant in the near future should discuss the risks and benefits of salicylic acid, sulfur and coal tar with their doctor, who may advise against the treatment.
  • This medicine could potentially be excreted into breast milk. Breastfeeding mothers should discuss any potential risks to their baby with their healthcare provider.

Storage

Salicylic acid, sulfur, and coal tar should be stored in its original packaging at room temperature, in a dedicated medicine cabinet if possible. The manufacturer states that this medicine should be kept away from moisture – therefore this product is not suitable for storage in a bathroom. As with all medications, salicylic acid, sulfur and coal tar should be kept in a safe place, out of the reach of children and pets. If the patient has unwanted or unused salicylic acid, sulfur, and coal tar, they should dispose of it in a safe and hygienic manner. Most pharmacies can offer advice on how to best dispose of unwanted medicines.

Summary

When combined into a topical cream or shampoo, salicylic acid, sulfur, and coal tar create an effective treatment for skin conditions of the scalp and can reduce the signs and symptoms of dandruff, psoriasis, and dermatitis within a week.

However, there are some small risks associated with this medication, which is why patients are advised to be forthcoming about any allergies they may have in order to rule out unnecessary irritation as a result of using this medicine. To get the most out of this medication, patient and doctor are advised to work together to ascertain the best course or treatment in terms of dose and frequency.

Resources
Last Reviewed:
February 01, 2018
Last Updated:
January 27, 2018