How to Compound Your Own Coal Tar Ointment

If you have psoriasis, you may have tried coal tar ointments. These are sometimes called "LCD" ("Liquor Carbonis Detergens") compounds. 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 (or your dermatologist) decide they are best for you.

D.I.Y. Compounding, "V 2.0":

I wrote this article originally in 2019. The original version is below. In the article I described adding coal tar to Aquaphor ointment. But my emphasis was to show the various stages of creating this compound. It was a bit of trial and error, and as a consequence I did not keep track of how much coal tar to add. I ended the article with pictures of the various tints of compounds made with too little coal tar, too much coal tar, and the right amount, and promised to update the article.
Well, here's the promised update, 5 years later! I have used that jar of homemade compound throughout these five years. I apply a small amount each time, and my psoriasis has become quite mild - likely due to improvements in my diet throughout the years. When your diet is very anti-inflammatory, auto-immune diseases seem to become more and more mild. I had had 3 to 6 psoriasis plaques at any given time throughout this period, most in the same places, and they required just a dab of the ointment only every week or couple of weeks.

My original method was to make coal tar compound "from scratch" with Aquaphor.
This new method is much simpler. We'll simply use a pre-mixed psoriasis compound, and fortify it with extra coal tar. So the materials are:

One tube of Psoriasin ointment (readily available in stores). Note that Psoriasin has only 2% coal tar, likely due to restrictions sponsored by the pharmaceutical companies.

One 15 gram tube of Triamcinolone (or any other prescription compound). The OTC hydrocortizone ointments may not be quite strong enough.

A small amount of Coal Tar. Please see the original article below for info on obtaining it.

And that's it!!

Squeeze the small tube of the prescription compound into a container. Note that this time, I used only one 15 gram tube this time, whereas I used 30 grams last time. It's my opinion that the coal tar is the key ingredient.
Then squeeze about half of the Psoriasin into the container. I enlarged the opening of the Psoriasin tube to make squeezing easier, I used an empty glass jar that originally held Elderberry gummies.

Mix the two ointments

Add three teaspoons (0.5 oz) of Coal Tar. Try to use an "official" teaspoon baking tool, not an ordinary teaspoon. The author is "not" responsible if you use one of the chef's measuring utensils. . .
As you can see here, I had a 1/8 cup container (an old one - not the kitchen chef's), thinking I would need at least that much. The utensil was level full when I started, but I only used a small amount. I later measured the amount to be (approximately) 3 teaspoons.

The Finished Compound

Here is the finished compound. I have added all the rest of the Psoriasin and the remaining Triamcinolone This picture was taken out in the garage on the "Compound mixing table" (my workbench).	And this picture was taken of the finished compound on my kitchen table, with light from the dining room window. Compart these two pictures with the "Compounding Successs" image below, from the original article. The coloration is about the same. Note that the "Compounding Success" container is opaque, not clear glass.

Not strong enough? Try your compound. I have found coal tar to be much better than any prescription ointment. A small psoriasis plaque should be amost gone in a couple of days, maybe three. If not, add another half teaspoon of Coal Tar and re-mix. As noted in the original article below, my dermatologist said "Feel free to add more Coal Tar if necessary".

Light Sensitivity: I don't know if this compound is light sensitive or not. In my case, I don't care because it stays in a closed drawer in my bathroom. If you are going to leave it out, an opaque container might be in order.

D.I.Y. Compounding, "V 1.0" (The Original Article):

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!)

Oh, and don't do this in nice clothes!

When I told my dermatologist of my difficulties in finding a pharmacy which would do compounding, he fully supported my plan to do the compounding myself, and readily gave me the formula. Here it is:

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")

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 (instead of the suggested 60 gm). 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.

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/Aquaphor 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 of liquid that I poured out of the Coal Tar bottle. (This is the liquid that you see in the "First Attempt" image above.)

The one on the right is too weak. It was the last pre-compounded prescription that I received. But the compounding tech apparently interpreted the "10% LCD" in too weak a manner; this batch did not work well at all.

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. This implies that the actual amount of Coal Tar can vary.