Goeckerman Regimen Research Articles

Does tar belong in the Goeckerman regimen?

International Journal of DermatologyVolume 21, Issue 6 p. 331-332 Does Tar Belong in the Goeckerman Regimen? Mark J. LeVine M.D., Corresponding Author Mark J. LeVine M.D. From the Department of Dermatology, University Hospitals of Cleveland, Cleveland, OhioAddress for reprints: Mark J. LeVine, M.D., Department of Dermatology, University Hospitals of Cleveland, 2074 Abington Road, Cleveland, OH 44106Search for more papers by this author Mark J. LeVine M.D., Corresponding Author Mark J. LeVine M.D. From the Department of Dermatology, University Hospitals of Cleveland, Cleveland, OhioAddress for reprints: Mark J. LeVine, M.D., Department of Dermatology, University Hospitals of Cleveland, 2074 Abington Road, Cleveland, OH 44106Search for more papers by this author First published: July 1982 https://doi.org/10.1111/j.1365-4362.1982.tb03139.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume21, Issue6July 1982Pages 331-332 RelatedInformation

The Role of Tar in Goeckerman Therapy

Seventeen patients with psoriasis were treated with 5% crude coal tar in an absorbent ointment base (Aquaphor) to one half of the body and with the absorbent ointment base alone to the other half. They received twice-daily erythemogenic doses of ultraviolet irradiation (UVR). Both modalities, crude coal tar and absorbent ointment base alone, combined with UVR were equally effective in improving psoriatic plaques. On the basis of this and previous studies, we question the therapeutic role of tar in the Goeckerman regimen.

Hyperthermia in the Treatment of Psoriasis

The effectiveness of commercially available, chemically generated, topical exothermic pads that elevate skin surface temperature from 42 to 43 degrees C was stressed in 22 patients with psoriasis. Control sites were treated with conventional modalities such as Goeckerman's regimen, as well as with occlusion with nonexothermic pads. Skin lesions in 19 patients disappeared after the use of hyperthermia. The average time required for complete regression in the treated areas was 27 days with hyperthermia, compared with 44 days with Goeckerman's regimen. There were no hyperthermic side effects. Seventeen patients whose skin lesions disappeared with the use of both hyperthermia and Goeckerman's regimen were subsequently reexamined. The hyperthermia produced an equal or longer duration of remission than did Goeckerman's regimen.

Skin Cancer in Patients With Psoriasis Treated With Coal Tar

For many years, crude coal tar has been used for the treatment of psoriasis. The possible carcinogenic effect of crude coal tar and ultraviolet (UV) radiation (Goeckerman regimen), considered individually or in combination, has been of some concern to physicians. A 25-year follow-up study was completed on 280 patients with psoriasis who were hospitalized and treated with crude coal tar and UV radiation at the Mayo Clinic, Rochester, Minn, during the years 1950 through 1954. The results of this study suggest that the incidence of skin cancer is not appreciably increased above the expected incidence for the general population when patients are treated with coal tar ointments. It seems that the Goeckerman regimen (topical crude coal tar combined with UV radiation) can be used with minimal risk for skin cancer in the treatment of psoriasis.

Preliminary Report: Modified Goeckerman Therapy for Hospitalized Patients: Ambulatory Day Care Center and Improved Quantitative Dosimetry

The use of tar and ultraviolet light as an inpatient therapy for psoriasis was described by Goeckerman more than 50yr ago. Since that time it has been shown to be an effective treatment for psoriasis at numerous medical centers with the average period of hospitalization approximating 3weeks. This study was designed to evaluate whether inpatient treatment would be comprised if the patients were permitted to spend each night of the final week of treatment at home. Of 267 patients hospitalized in 1979 for Goeckerman therapy, 84 patients were selected for study. These were divided into two groups, A and B. Group A consisted of patients receiving 3weeks of inpatient care. Group B consisted of patients receiving 2weeks hospitalization for inpatient Goeckerman therapy and 1week of daily Goeckerman therapy in the ambulatory Psoriasis Treatment Center while spending the previous evening at home. Group A and group B were compared for rate and degree of improvement and for duration of remission following hospital discharge. For purposes of statistical comparisons, patients from groups A and B were matched by sex, age, and date of admission to the study. Both groups showed 80–90% clearing in the first 3weeks. For patients in group A, the average total radiation received was 61.3 J/sq cm of UVA and 9.85 J/sq cm of UVB. The average total radiation received by group B was 61.3 J/sq cm of UVA and 8.63 J/sq cm of UVB. Neither difference was statistically significant ( p Both Group A and group B had similar numbers of patients who exacerbations required readmission to the hospital for either repeat Goeckerman therapy or for other types of treatment during the 18 mo follow-up period. The length of time before rehospitalization was also similar for both groups. These findings are of a preliminary nature. However, it appears that the rate of clearing and period without exacerbation in psoriasis can be maintained by modifying the traditional inpatient Goeckerman regimen.

Long-term modified Goeckerman regimen for psoriasis using an ultraviolet B light source in the home.

An ultraviolet B (UVB) unit for the home was built for each of fifty-six people with extensive psoriasis. This light unit is constructed to deliver the most cost-effective radiation while remaining portable, height-adjustable, and free of the necessity to nail or screw the unit to the wall. Six 40-watt fluorescent sunlamps in an open configuration will deliver 150 to 170 mu watts/cm2 to one half of the body at a distance of 30.5 cm (1 minimal erythema dose [MED] = 1-2 min). Fifty-five patients completed a modified Goeckerman program starting at 1-minute exposures, with weekly increases of light by 1 minute until 6 or 8 weeks of treatment had elapsed. All patients were cleared of psoriasis (scalp not included). Fifty-one patients accomplished the clearance program totally in the home. Over 80% of them remain virtually clear as they have maintained a 6- to 8-minute tar-light program two to five times a week. Thirty-seven subjects have used this home UVB unit for over a year. Our results with the modified Goeckerman treatment of psoriasis in the home show that: (1) only six nonenclosed lamps are needed for the economical clearing and maintenance of many psoriatics, and (2) the initial clearing rate using forty-two to sixty suberythemal treatments is outstanding.

Incidence of skin cancers in patients with atopic dermatitis treated with coal tar: A 25-year follow-up study

Coal tar ointments have been used for many years in the treatment of chronic eczematoid dermatitis. The possible carcinogenic effect of coal tar ointment and ultraviolet light (Goeckerman regimen), considered individually or in combination, has been of concern to physicians. A 25-year follow-up study was completed on 426 patients with atopic dermatitis and neurodermatitis who were hospitalized and treated with coal tar ointments and ultraviolet light at the Mayo Clinic from 1950 through 1954. These results were compared with those from a similar study that examined patients with psoriasis who also were treated with coal tar ointments and ultraviolet light. The results of this study suggest that the incidence of skin cancer is not significantly increased above the expected incidence for selected populations of the United States. This study offers reassurance about the relatively small risk of skin cancer developing in patients with atopic dermatitis and neurodermatitis treated with coal tar ointments and ultraviolet light (Goeckerman regimen).

Components of the Goeckerman Regimen

Although application of tar products and subsequent exposure to ultraviolet radiation (the Goeckerman regimen) has repeatedly been demonstrated to be effective therapy for psoriasis, the therapeutic role of each component has remained uncertain. Utilizing the bilateral comparison technique in 30 hospitalized patients with chronic stable plaque-type psoriasis vulgaris, we closely monitored the clinical responses to ultraviolet radiation (Westinghouse fluorescent FS40 bulbs, 290--400 nm) and a variety of tar preparations and lubricant vehicles in combination and separately. We found that: 1) 4 weeks of maximally-aggressive exposure to ultraviolet radiation alone will markedly improve, but not completely clear, psoriasis unless combined with a tar preparation or lubricating base; 2) 5% crude coal tar plus ultraviolet radiation offers no clear advantage or benefit over lubricating base plus ultraviolet radiation; and 3) none of the tar preparations tested offered any consistent advantage over any other preparation.

ULTRASTRUCTURE OF THE CAPILLARY LOOPS IN THE DERMAL PAPILLAE OF PSORIASIS

Electron microscopy was used to define the ultrastructure of the capillary loops in the dermal papillae of psoriatic lesions. Pustular psoriasis of von Zumbusch and psoriasis vulgaris were studied before and after treatment with the Goeckerman regimen. Capillary loops were reconstructed from 1-mum plastic-embedded sections. Ultrathin sections were taken at intervals for correlation with the 1-mum sections. There were no ultrastructural differences between the capillary loops in psoriasis vulgaris and pustular psoriasis. The intrapapillary portion of the loop was predominantly a venous capillary. Four basic ultrastructural loop patterns were recognized which can serve as markers in studying the responses of psoriatic loops in various experimental situations. Following 3 weeks of Goeckerman therapy, the morphology of psoriatic capillary loops changed from venous capillaries to arterial capillaries which are found in the papillae of normal skin. This transformation was observed to begin 48 to 72 hr after the initiation of therapy.

Letter: Modified Goeckerman regimen: decreased treatment time.

To the Editor.— During the last decade, we modified our Goeckerman regimen. The psoriatic patient received a topical application of a corticosteroid (usually triamcinolone acetenide, 0.1% or 0.025%) and was covered for eight to ten hours daily with a plastic exercise suit (space suit). Some patients preferred to wear the plastic suit during the eight hours before sleep; however, most used it at night. The ambient temperature in our inpatient unit is near 22 C most of the year; yet, sweating produced enough discomfort in some to necessitate discontinuation of treatment. Minimal folliculitis did not require discontinuation; frank furunculosis did. Previous duration of hospitalization for the Goeckerman regimen was approximately three weeks. With this modified regimen, treatment averaged 13.4 days for the last 53 patients. Discharge occurred when lesions were no longer grossly acanthotic. We do not have adequate statistics to verify that the relapse rate is no higher than

The Goeckerman Treatment of Psoriasis

The Goeckerman regimen of crude coal tar application to all skin areas, followed by ultraviolet irradiations has continued as the basic treatment for the severely involved hospitalized psoriatic patient at the Mayo Clinic. A review indicates ready patient acceptance, good clinical benefit, and an absence of complications from therapy. The average duration of remissions induced by this therapy seems longer than of those occurring spontaneously.