What Is Coal Tar Used For Skin Uses And Risks? Key Facts

Coal tar is a thick, dark byproduct of coal processing that has been used to treat skin conditions for more than a century. It is still an active ingredient in many over-the-counter shampoos, lotions, and ointments sold in the United States. It helps slow the rapid skin cell turnover behind psoriasis and relieves itching and scaling in conditions like seborrheic dermatitis and eczema.

Coal tar is not a cure. It manages symptoms, and it works more slowly than some newer treatments. It also carries real cautions, including skin irritation and a long-debated but still unresolved question about cancer risk with long-term use. Here is what the evidence actually shows.

What Is Coal Tar Used For Skin Uses And Risks?

Coal tar is used to reduce scaling, itching, and inflammation in several chronic skin conditions. The Food and Drug Administration permits it in over-the-counter products at concentrations between 0.5% and 5% for treating dandruff, seborrheic dermatitis, and psoriasis, and it appears in prescription products too.

The main conditions it treats include:

• Psoriasis — especially scalp psoriasis and plaque psoriasis on the body
• Seborrheic dermatitis — the flaky, greasy scaling that affects the scalp, eyebrows, and face
• Dandruff
• Eczema and other itchy, scaly rashes, though it is used less often for these

Coal tar has been in clinical use since roughly the early 1900s. That makes it one of the oldest skin treatments still in regular use. It fell out of favor somewhat as corticosteroids and newer biologic drugs arrived, but it never disappeared. Many dermatologists still recommend it, particularly for scalp psoriasis and for people who want to avoid steroids or use them less.

How Does Coal Tar Work on the Skin?

Coal tar slows down the unusually fast turnover of skin cells that drives psoriasis and similar conditions. In psoriasis, skin cells multiply far faster than normal, which builds up into thick, scaly plaques. Coal tar appears to reduce that cell division and also helps break up scale and ease itching.

The precise mechanism is not fully understood. Coal tar is a complex mixture of hundreds of chemical compounds, and researchers have not pinned down exactly which ones do what. What is well established is the effect: it reduces scaling and slows cell growth. The exact biology behind that effect remains only partly explained.

One practical point people often miss: coal tar works slowly. It is not a fast fix. It may take several weeks of regular use before you notice clear improvement. That is different from how steroids work, which can calm inflammation within days. Understanding this matters, because many people stop coal tar too early thinking it failed.

What Forms Does Coal Tar Come In and How Is It Used?

Coal tar comes in many forms, and the right one depends on the condition and where it is on the body. Shampoos suit the scalp. Creams and ointments suit the body. Solutions and bath additives are used for wider areas.

Common product types include:

• Shampoos for scalp psoriasis, dandruff, and seborrheic dermatitis
• Creams and lotions for thinner plaques and larger areas
• Ointments, which are thicker and often used for stubborn plaques or overnight
• Bath oils and solutions for soaking larger areas of skin
• Scalp treatments and gels for direct application

General patterns of use, based on product labeling and common dermatology practice, include leaving tar shampoo on the scalp for a few minutes before rinsing, and applying creams or ointments to affected areas once or twice daily. Always follow the specific product label, because instructions vary by product and strength.

Coal tar has a strong smell and can stain clothing, bedding, and light-colored hair. It can also make skin more sensitive to sunlight. These practical drawbacks are a big reason some people prefer alternatives, even when tar works well.

What Are the Risks and Side Effects of Coal Tar?

The most common side effects are skin irritation, redness, stinging, and dryness, especially on sensitive areas like the face or skin folds. Coal tar can also cause folliculitis, an inflammation of the hair follicles that looks like small bumps. These reactions are usually manageable by using a lower strength or applying less often.

Coal tar increases sensitivity to ultraviolet light, so sunburn can happen more easily. People using it are generally advised to limit sun exposure and use sun protection on treated skin.

The bigger question is cancer risk. Coal tar contains polycyclic aromatic hydrocarbons, some of which are known carcinogens in other contexts. This has raised concern about long-term use on the skin. The evidence here is genuinely mixed and incomplete. Some studies have suggested a possible link between long-term coal tar treatment and skin cancer, while others have not found a clear increase. No large, definitive trial has settled the question either way.

What can be said honestly: the concern is not proven, but it is not fully dismissed either. Most dermatologists consider short-term and intermittent use acceptable, and many consider long-term use reasonable when benefits are clear. That is a judgment call made case by case, not a settled certainty. Anyone planning long-term daily use over many years should discuss it with a doctor rather than assume it is risk-free.

Coal tar should not be used on broken, infected, or acutely inflamed skin, and it is generally not recommended for use in pregnancy or breastfeeding without medical advice. Data on safety in pregnancy is limited, so this is a conversation to have with a clinician rather than a decision to make alone.

How Does Coal Tar Compare With Other Psoriasis Treatments?

Coal tar is one option among many, and it sits toward the milder, older end of the treatment range. It is generally less potent and slower than prescription corticosteroids, and far less effective for severe psoriasis than newer systemic drugs and biologics. For mild to moderate scalp and plaque psoriasis, though, it remains a reasonable choice.

Here is a plain comparison of how coal tar fits alongside common alternatives:

• Corticosteroids — faster anti-inflammatory action, widely used, but long-term use can thin the skin; often combined with coal tar rather than replacing it
• Vitamin D analog creams — slow cell turnover like tar, generally less messy and less smelly, often preferred for body plaques
• Salicylic acid — mainly removes scale and is often used alongside tar or steroids
• Biologics and systemic drugs — reserved for moderate to severe psoriasis; far more effective for widespread disease but carry their own risks and costs
• Light therapy — uses controlled UV exposure; coal tar is sometimes combined with UV treatment in a approach called Goeckerman therapy, used in some clinical settings

Coal tar’s advantages are that it is inexpensive, available without a prescription in many forms, and does not carry the skin-thinning risk of long-term steroids. Its disadvantages are the smell, staining, slow action, and the unresolved long-term safety question. For many people with mild scalp psoriasis, those trade-offs are acceptable.

Who Should Be Careful With Coal Tar?

Coal tar is not right for everyone. People with certain sensitivities or circumstances should be cautious or avoid it, and anyone unsure should check with a doctor or pharmacist.

Groups who should take extra care include:

• People with very sensitive skin or known reactions to tar products
• Anyone with open sores, infected skin, or suddenly worsened inflammation
• Pregnant or breastfeeding women, who should get medical advice first because safety data is limited
• People who spend a lot of time outdoors, given the increased sun sensitivity
• Anyone considering long-term daily use over many years, who should discuss the cancer-risk question with a clinician

Coal tar can also stain and has a strong odor, which is a practical rather than medical concern but a real one for daily life. Some workplaces and social situations make it hard to use regularly, and that affects whether it will actually work for a given person.

Is Coal Tar Still Worth Using?

Coal tar remains a legitimate, evidence-supported treatment for psoriasis, seborrheic dermatitis, and dandruff, especially in milder cases and on the scalp. It is old, cheap, and still recommended by many dermatologists. It is not a relic, and it is not a miracle either.

The honest summary: it works for many people, it works slowly, and it comes with practical drawbacks and an unresolved long-term safety question. It is best used with realistic expectations and, for long-term use, with a doctor’s input. If you try it, give it several weeks before judging whether it helps, and stop if your skin becomes irritated or worsens.