The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Summary

Psoriasis is a chronic, immune-mediated inflammatory skin disease. The Goeckerman regimen, formulated for the treatment of psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). The following protocol is for the administration of Goeckerman therapy for the treatment of moderate-to-severe psoriasis.

Abstract

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population. The Goeckerman regimen consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT). Goeckerman therapy is extremely effective and relatively safe for the treatment of psoriasis and for improving a patient's quality of life. In the following article, we present our protocol for the Goeckerman therapy that is utilized specifically at the University of California, San Francisco. This protocol details the preparation of supplies, administration of phototherapy and application of topical tar. This protocol also describes how to assess the patient daily, monitor for adverse effects (including pruritus and burning), and adjust the treatment based on the patient's response. Though it is one of the oldest therapies available for psoriasis, there is an absence of any published videos demonstrating the process in detail. The video is beneficial for healthcare providers who want to administer the therapy, for trainees who want to learn more about the process, and for prospective patients who want to undergo treatment for their cutaneous disease.

Introduction

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2-3% of the population.¹ One-third of the patients experience generalized psoriasis that causes debilitating physical and psychological effects. The Goeckerman regimen, first published in 1925 for the treatment of generalized psoriasis, consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT).² Though newer internal agents such as biologics have enhanced the treatment of psoriasis, Goeckerman therapy remains as an extremely effective option, while providing a long duration of remission.^3,4 In a published stud....

Protocol

1. Evaluation and Preparation

1. Perform a complete history and physical prior to initiating therapy. In the history and physical, document important information such as current/past medications, response to past psoriasis therapies, any history of adverse reactions to ambient sunlight or phototherapy, severity of pruritus, and sleep quality.
2. Set up a clinic room with all the necessary material for dermal application of medications and occlusion [See Materials Section and Figure 1]. Also, place other materials in the room such as gloves, plastic wrap, socks, and scrubs/pajama gowns.
3. Assess the patient for ....

Results

In a study performed at our center at the University of California San Francisco, PASI75 response (a 75% improvement in the Psoriasis Assessment Severity Index) was achieved in 100% of patients receiving Goeckerman (n = 25) over a 3-month time period.⁵ 24/25 patients needed only 2 months to achieve PASI75, while the remaining patient obtained a PASI75 response at 3 months. In another study, Menter et al. administered the Goeckerman regimen for 300 patients and 100% of the patients achieved 90% or more.......

Discussion

The Goeckerman Regimen protocol outlined above is utilized at UCSF and can be varied in multiple ways according to the patient's response to therapy. Since the patient is seen and examined every day, the protocol can be individualized for each patient to ensure maximum efficacy. The traditional Goeckerman treatment solely consisted of the use of CCT and UVB phototherapy.² However, the regimen has been modified to include the use of topical corticosteroids (and at times other topical medications such as calcipo.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
2% Crude Coal Tar in White Petrolatum or Cetaphil	Compounded at Pharmacy
5% Crude Coal Tar in White Petrolatum or Cetaphil	Compounded at Pharmacy
10% Crude Coal Tar in White Petrolatum +/- 2/5/10% Salicyclic Acid	Compounded at Pharmacy
10% Crude Coal Tar in Cetaphil	Compounded at Pharmacy
20% Liquid Carbonis Detergenis in Nutraderm	Compounded at Pharmacy
20% Liquid Carbonis Detergenis in Aquaphor or Cetaphil	Compounded at Pharmacy
Triamcinolone 0.1% ointment/cream/lotion	Prescription Medication - Generic
Desonide 0.05% cream/ointment	Prescription Medication - Generic
Fluocinolone 0.01% oil	Prescription Medication - Generic
Clobetasol 0.05% ointment/cream	Prescription Medication - Generic
Hydrophillic Ointment	Over the Counter - Generic
Mineral Oil	Over the Counter - Generic
Narrow-Band Phototherapy Unit	National Biologic Corporation
Broad-Band Phototherapy Unit	National Biologic Corporation