First formulated in 1925 by American dermatologist William H. Goeckerman (1884–1954), Goeckerman therapy continues to be used due to its
efficacy and
safety profile.[1] Individual institutions have modified the Goeckerman regimen and developed their own protocols. Standard therapy includes use of 2–4% crude
coal tar in a
petroleum base applied daily to the
psoriatic plaques. The minimum period of time for tar application is 2-hours, although it has been recognized that greater periods of time produce better results.[2] The patient is then exposed to broad-band ultraviolet B (
UVB) radiation, although narrow-band
UVB may also be used.[3] Laboratory studies have shown that the combination of
coal tar and
UV light reduces epidermal
DNA synthesis.[4]
Modifications
In 1953, John Ingram, an English dermatologist, added topical
anthralin paste to his Goeckerman regimen. This is known as the Ingram method.[5]
Cost
Recent publications have compared Goeckerman therapy with treatment with more expensive
biologic agents.[6][7] Historically, Goeckerman therapy was performed as an
inpatient treatment. However, today the treatment can be done with reduced cost as an
outpatient. It has been stated by de Miguel et al., that an annual three-week
outpatient course of Goeckerman treatment costs $10,000 to 12,000 but repeat treatment may be extended to two years with the use of a $2,000 home
UVB treatment lamp.[6] The authors state that
biologic therapy costs $22,000 to 59,000 per year.
Safety
Goeckerman regimens use crude
coal tar, which contains
polycyclic aromatic hydrocarbon, a
carcinogen.[8][9] However, Goeckerman therapy is considered safe although use of tar may have the side-effects of
contact dermatitis and mild local burning due to tar
hypersensitivity. A
retrospective study by Stern et al., of 1,373 patients concluded that there was an increase in
skin cancers in those receiving repeated Goeckerman treatments compared to the
control group.[10] This has been refuted by other authors, including Pittelkow et al., who state there has not been an increase in
skin cancers among those treated compared to the general population[11] and Menter and Cran, who felt that the Stern study was too crude to have validity and felt a 10-year prospective study would be needed to confirm safety concerns.[2]
Efficacy
With the increased use of biologic medications in treatment of moderate-to-severe
psoriasis there has been a shift away from Goeckerman therapy. A 2007 comparative study of psoriasis treatment found Goeckerman therapy to be more efficacious at 12-weeks than biologics.[12] It has also been successfully used in patients who have failed some biologic therapies.[13]
References
^Goeckerman, W. H. (1925). "The treatment of psoriasis". Northwest Med. 24: 229–231.
^
abMenter, Alan; Cram, David L. (July 1983). "The Goeckerman regimen in two psoriasis day care centers". Journal of the American Academy of Dermatology. 9 (1): 59–65.
doi:
10.1016/S0190-9622(83)70107-6.
PMID6886105.
^Lee, E.; Koo, J. (12 July 2009). "Modern modified 'ultra' Goeckerman therapy: A PASI assessment of a very effective therapy for psoriasis resistant to both prebiologic and biologic therapies". Journal of Dermatological Treatment. 16 (2): 102–107.
doi:
10.1080/09546630510033140.
PMID16019624.
S2CID24668735.
^Leon, Argentina; Nguyen, Alain; Letsinger, Julie; Koo, John (22 March 2007). "An attempt to formulate an evidence-based strategy in the management of moderate-to-severe psoriasis: a review of the efficacy and safety of biologics and prebiologic options". Expert Opinion on Pharmacotherapy. 8 (5): 617–632.
doi:
10.1517/14656566.8.5.617.
PMID17376017.
S2CID25699724.
^Serrao, Rocco; Davis, Mark D.P. (February 2009). "Goeckerman treatment for remission of psoriasis refractory to biologic therapy". Journal of the American Academy of Dermatology. 60 (2): 348–349.
doi:
10.1016/j.jaad.2008.10.016.
PMID19150284.
Further reading
Kortuem, Kimberly R.; Davis, Mark D. P.; Witman, Patricia M.; McEvoy, Marian T.; Farmer, Sara A. (22 September 2010). "Results of Goeckerman Treatment for Psoriasis in Children: A 21-Year Retrospective Review". Pediatric Dermatology. 27 (5): 518–524.
doi:
10.1111/j.1525-1470.2010.01124.x.
PMID21182642.
S2CID22816536.