How to Compound Your Own Coal Tar Ointment

If you have psoriasis, you may have tried coal tar ointments. These are sometimes referred to "LCD" ointments - "Liquor Carbonis Detergens". Coal tar has been used as psoriasis treatment for years. I won't spend time discussing its advantages or disadvantages compared to other treatments, but will simply note that in my own experience it's the only thing that consistently works.
 Coal tar by itself is usually a liquid, and is difficult to apply without making a mess, so it is better when mixed into an ointment. Many dermatologists prescribe the coal tar along with some sort of steroid-based products for an extra kick.
 So this brings us to the subject of this article: Where can one find a pharmacy that will "compound" the coal tar and the other products into an ointment?!? I for one am finding it more and more difficult to find a pharmacy that will consistently do this.

The solution? Compound it yourself!! Here's how.
 It's DISCLAIMER time: Please note that I am not recommending coal tar as a solution to psoriasis. This article is written simply to help you MAKE coal tar ointments if you decide they are best for you.

So here's what you will need to make your own coal tar compound:

The coal tar itself (Duh!) Humco is one supplier. The bottle shown is "prescription strength" 20% coal tar, along with alcohol and also polysorbate 80 (an emulsifier).
 NOTE: From a pharmacy, it is prescription only. Further, the prescription must be EXACT!! It must say 20% and 16 oz. My dermatologist's office had to communicate three times with the pharmacy before they would release it.
 However, it might be noted that it's available online through legitimate sources!

Possibly other prescription ointments. Several dermatologists have written prescriptions for me that have contained topical corticosteroid ointments. They do seem to enhance the effect of the coal tar itself. Examples

Fluocinonide. My original prescription (years ago) included this. But the manufacturer has within the last two years artificially raised the price to $280 for 60 gm! Insurance balked.

Chlorbetasone

Triamcinolone. This is what my doctor chose. It's in image on the right.

One or more plastic, nalgene, or glass containers with wide lids.

Some way to measure ounces. (Not from the kitchen! You'll catch h_ _ _ from the cook!)

ingredients

The formula, as supplied by my doctor was:

2 oz of the 20% coal tar.

60 gm of the corticosteroid ointment, in this case, the Triamcinolone.

Add sufficient Aquaphor to end up with 6 oz total. (Want to sound like a good compounding tech? The compounding term for this is "q.s", or "qs". That's the Latin for "quantum sufficit", or "the amount that suffices". So you say "Add Aquaphor qs to 6 oz")

Not this

First attempt:

Well, I got off to a bad start. The image on the left shows how NOT to do it!! My first attempt was to pour the liquid coal tar into the container, so I could measure it. Then I squeezed two of the 15 gm tubes of ointment and tried to mix the coal tar with the ointment.
 It was at this point that I discovered that you can't mix pastes into liquids! They just won't mix. I won't go into the details, but suffice it to say that my first attempt to compound was a disaster!



Compounding SUCCESS

So what you do instead is place the ointments in the container first. Then you add the liquid Coal Tar. It's a lot like mixing the Thanksgiving gravy. Add the flour to the turkey drippings a little bit at at time, stirring constantly. Add water (if desired) a little bit at a time while stirring. If you add the flour to some water and then attempt to pour in the turkey drippings, it will be lumpy!
 So. . .

First: Squeeze the corticosteroid ointment(s) into the container. In this case, I started with 30 gm of the Triamcinolone - 2 of the 15 gm tubes. Why? Because I like to follow the rule: "Use the least amount of medication to do the job".

Add about the same amount of the Aquaphor.

Now add a small portion of the liquid coal tar. Stir well. You will find that they mix easily. Keep adding portions of the coal tar and mix well each time. I stopped at somewhere around 1 oz instead of 2 oz. (SEE below)

Then add the Aquaphor, a little bit at a time, until you reach the 6 oz goal. You "qs to 6 oz".

NOTE: "hydrophobic" vs "hydrophilic":
 We add some of the Aquaphor to the Triamcinolone ointment prior to adding the liquid Coal Tar because Aquaphor more readily accepts liquids. Most prepared ointments use a "Petrolatum" or "White Petrolatum" base. Petrolatum is considered hydrophobic - it doesn't mix well with water or other liquids. But Aquaphor is hydrophilic, and will accept water and other liquids more easily.
 Further, Aquaphor has been around for quite some time, and is an excellent treatment for dry skin in its own right. My first Coal Tar prescription from 10 - 15 years ago was Aquaphor-based.

mixture

So. . . how much of the Coal Tar to add:
 ANS: Make it look like the middle one in the image below! (Or the one in the image just above, under "Compounding SUCCESS".)

The prescriptions that I have always got for the pre-compounded Coal Tar ointments called for "10% LCD plus XX% cortiosteroid. It was never clear to me what that "10%" actually meant, and it was apparently not clear to the various pharmacy compounding techs either. The original mixtures I received years ago were usually fairly dark brown and had the distinct coal tar odor. But the most recent compounds have been a light almond color, with much less of the smell.
 It would seem to me that if I have liquid Coal Tar/LCD at 20% strength, then 1 oz of the Coal Tar mixed with 1 oz of ointment would yield 10%. But after mixing my own I find that's far too strong.
 So, based on what the original compounded prescriptions used to look like, I would offer the following as a guide.

The one on the left is too strong. I added approximately 1 to 1 1/2 oz out of the original 2 oz that I poured out of the bottle (the liquid showing at the bottom of the container in my "First Attempt" section).

The one on the right is too weak. It was the last pre-compounded prescription that I received. The pharmacist created it along with a standard over-the-counter hydrocortizone, to substitute for the Fluocinonide when it became prohibitably expensive. But he apparently interpreted the "10% LCD" in too weak a manner; the ointment was less effective than I had been used to..

The container in the middle looks like the original mixture that I used to get for years. It is quite effective. Thus I recommend that you add sufficient Coal Tar to produce that tint. It's also shown in the image just above, under "Compounding SUCCESS".

Yes. I know "sufficient Coal Tar to produce that tint" is a bit nebulous! When I mix the next batch, I will take note of the amount of coal tar used, and will update this article. When my doctor gave me the formula above, he actually did say that if I found it too weak, to feel free to add a bit more Coal Tar.

compare

Copyright © 2019 J.A.