The Goeckerman regimen was introduced in 1929 for the
treatment of psoriasis. The procedure was very messy, time-consuming (up to 10
hours) and required a great deal of persistence. Despite the obvious drawbacks,
the Goeckerman regimen proved to be very effective and as such was held as the
standard therapy for psoriasis in the last century.
Psoriasis is a disorder in which T-cells induce
inflammation and excessive proliferation of skin cells. The diseased area
consists of cells that are dividing and proliferating at a much quicker rate
than normal. It manifests as thick, red colored plaques.
Goeckerman’s regimen is aimed towards reducing the thickness of the skin by
slowing down the rapidly diving cells, as well as reducing the inflammation.
First, a crude coal tar ointment is applied for 2-10 hours over the affected
area then washed off prior to light treatments. The tar used is a black viscous
fluid formed from the distillation of heated coals. Coal tar ointment contains
properties that inhibit proliferation of the diseased epidermis. However, it’s
most unique quality is its ability to photosensitize the skin so that subsequent
light radiation is more effective.
After the coal tar ointment has been completely washed off of the affected
areas, the patient’s skin is exposed to light in a light box. The light is first
absorbed by cells in the outermost layer of the skin—the epidermis. The light
absorbed has sufficient energy to change DNA structure in the nuclei of skin
cells. When such an alteration occurs, DNA synthesis/replication is temporarily
blocked. If DNA is not properly replicated, the cells cannot proceed into cell
division. In other words, by stopping or delaying the cell cycle, UV light is
limiting the proliferation and thickness of the psoriatic plaque. UV light is
also responsible for reducing the inflammatory response generally found in
psoriasis.
With the use of home UVB NB units, the Goeckerman regimen
could be considered another optional treatment for psoriasis.
Indicators that could suggest a more aggressive treatment is needed,
generally include the involvement of large areas (more than 10% of body surface
area) or the involvement of surfaces that result in occupational disability.
This treatment has shown substantial improvement in 80% of patients.
Benefits:
A high rate of success
It can suppress psoriasis for a relatively long time.
Risks:
It is also known that both crude tar and UVB are carcinogens.
Despite the carcinogenic effects, Goeckerman’s regimen may still be the safest
option for people with moderate to severe disease as the risks are limited to a
very small increase in skin cancer induction
It’s a messy process
Cold tar can cause acne-like eruptions and skin irritation.
