Dithranol Essay

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Dithranol (anthralin) [1,2]
 The role of salicylic acid in stabilizing dithranol formulations was an accidental discovery, and led to the development of the Ingram regimen [5], which has played a central part in psoriasis management since, especially in Europe. After a tar bath in which scales and the previous applications are removed, sub erythema UVB is given, and the lesions then precisely covered with dithranol paste. The initial concentration is 0.05 or 0.1%, increasing cautiously up to 4% according to response, and aiming to avoid irritation of the normal or psoriatic skin [5–7]. In skilled hands, most patients with discoid psoriasis can be cleared in 3 weeks, leaving deep brown staining (Fig. 20.22) of the treated skin, which soon disappears after treatment is stopped. Dithranol paste is not suitable for the head and neck, flexures or genitalia, where it is liable to spread and is too irritant; it is highly irritant…show more content…
Dithranol in 0.0125% clobetasol propionate (quarter-strength Dermovate) ointment was reported to produce more rapid clearing than dithranol in Lassar’s paste[37]. In this study, the steroid combination was also associ- ated with a more rapid relapse rate [38][39][40][41]. Notwithstanding these developments, any form of dithranol therapy requires careful control and explanation if the patient is not to become quickly disenchanted. The drug has the great virtue of lacking systemic toxicity, although if very high concentrations become general, continued vigilance will be necessary. Allergic contact dermatitis is extremely rare but has been documented [42]. Overall, the relative impracticality of dithranol therapy as compared to topical vitamin D analogues indicates that use of this effective and safe therapy is in decline, particularly for outpatient
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