Not scheduled (Non-scheduled drug)

Topical

• Cream: 0.1%, 0.25%, 0.5%, 1%

• Ointment: 0.1%, 0.25%, 0.5%, 1%

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

▶ Psoriasis vulgaris (chronic plaque psoriasis)

Apply exclusively to lesional skin. Suitable for thick, stable plaques only — avoid face, flexures, genitalia, and acutely inflamed lesions.

Parameter Recommendation

Starting dose 0.1% cream/ointment once daily; contact time 10 minutes, then wash off

Titration Increase contact time by 5–10 minutes every 3–5 days as tolerated; increase concentration stepwise (0.1% → 0.25% → 0.5% → 1%)

Usual maintenance dose 0.5–1% once daily for 30–60 minutes (short-contact therapy)

Maximum dose 1% cream/ointment; maximum contact time 60 minutes/day

Clinical Notes:

• "Short-contact therapy" (apply, leave for specified time, wash off) is preferred to reduce irritation

• If short-contact therapy is well-tolerated for 2–3 weeks, may consider overnight "leave-on" application with lower strength (0.1–0.25%)

• Wash hands thoroughly after application; protect perilesional skin with petroleum jelly

• Treatment course: 6–8 weeks; reassess response at 4 weeks

Secondary Indications — Adults (Off-label, if any)

Indication Dose Duration Notes

Alopecia areata (OFF-LABEL) 0.1–0.5% cream once daily to affected scalp areas; short-contact 10–30 minutes Up to 12 weeks; discontinue if no response by 8–12 weeks Specialist only; evidence limited to case series; not standard of care in India

PAEDIATRIC DOSING (Specialist Only)

Primary Indications

▶ Chronic plaque psoriasis — Age ≥5 years

Parameter Recommendation

Starting dose 0.1% cream/ointment once daily; contact time 5–10 minutes

Titration Increase contact duration by 5 minutes every 4–7 days as tolerated

Usual maintenance dose 0.1–0.25% once daily for 15–20 minutes

Maximum dose 0.5% cream/ointment; maximum contact time 30 minutes/day

Clinical Notes:

• Avoid face, genitalia, and flexural areas

• Higher risk of irritation due to thinner skin — use under specialist supervision

• Protect surrounding skin with emollient barrier

Secondary Indications — Paediatric Doses (Off-label, if any)

Indication Dose Duration Notes

Alopecia areata (OFF-LABEL) 0.1% cream; short-contact 5–10 minutes once daily; increase cautiously 8–12 weeks trial Specialist only; age ≥12 years only; not widely practiced in Indian paediatric dermatology; high irritation risk

⚠️ Not recommended below 5 years of age except under strict dermatologist supervision

No adjustment required — topical use with negligible systemic absorption

Negligible systemic absorption with topical application

• Known hypersensitivity to anthralin or formulation excipients

• Acute pustular psoriasis or erythrodermic psoriasis

• Acutely inflamed or unstable psoriatic lesions

• Application on face, intertriginous areas, or genital region

• Open wounds or erosions at application site

• Avoid contact with eyes, mucous membranes, and uninvolved skin

• Children have increased skin permeability — higher irritation risk

• Use with caution in patients with thin or atrophic skin

• Staining of skin, nails, hair, clothing, and bathroom fixtures is expected — counsel patients

• Do not use on body surface area exceeding 10% initially

• Erythema and irritation are expected initially; distinguish from allergic contact dermatitis

Parameter Recommendation

Overall safety Not clearly established; limited human data

When to use May be considered for limited skin areas if benefit outweighs risk; specialist supervision required

Preferred alternatives Emollients, calcipotriol (with caution), low-potency topical corticosteroids

Monitoring Local irritation, allergic contact dermatitis

Parameter Recommendation

Compatible with breastfeeding Generally yes, if not applied on breast/nipple area

Drug levels in milk Negligible (minimal systemic absorption)

Preferred alternatives None specifically required if precautions followed

Infant monitoring Observe for skin irritation if extensive maternal application; avoid direct skin contact between treated areas and infant

Parameter Recommendation

Starting dose 0.1% cream/ointment; contact time 5–10 minutes

Titration Slower than adults; increase by 5 minutes every 5–7 days

Special considerations Thinner, more fragile skin increases irritation risk; increased bruising susceptibility; monitor closely for burning/blistering

None documented — topical agent with negligible systemic absorption

Avoid:

• Concurrent application of other topical irritants (salicylic acid preparations, benzoyl peroxide) — increased risk of severe local irritation

Interacting Drug/Class Effect Management

Topical corticosteroids May reduce anthralin efficacy; altered local pH Apply at separate times; use corticosteroids for flares only

Coal tar preparations Additive irritation; unpredictable skin reactions Stagger applications by several hours if combined

UVB phototherapy Heightened skin irritation and inflammation Avoid concurrent use; wash off anthralin before UV exposure

• Local skin irritation, erythema, burning sensation (especially during initial 1–2 weeks)

• Temporary brownish-purple staining of treated skin

• Dryness and scaling at application site

• Staining of clothing, bedding, and bathing surfaces

• Perilesional irritation if applied beyond plaque margins

Adverse Effect Action Required

Allergic contact dermatitis Discontinue immediately; consider patch testing

Severe irritation with blistering/vesiculation Discontinue; symptomatic treatment; dermatology review

Accidental ocular exposure Immediate copious irrigation with water; urgent ophthalmology consultation

Phase Parameters

Baseline Document lesion location, thickness, chronicity; confirm absence of facial/flexural involvement; photograph if possible

During initiation (first 4 weeks) Weekly assessment for irritation, burning, allergic dermatitis; patient tolerability; adjust contact time accordingly

Long-term Reassess treatment efficacy at 4–6 weeks; discontinue if no improvement or worsening; periodic review every 6–8 weeks during continued use

• Dithranol (Menarini)

• Dritho-Scalp

• Antriderm

• Antra-Sal

Note: Anthralin preparations may be extemporaneously compounded at tertiary dermatology centres

• Not under NPPA price control

• Availability may be limited to tertiary centre pharmacies and specialty dermatology clinics

• Reserve anthralin for thick, chronic, stable plaques unresponsive to first-line topicals — not suitable for acute/unstable psoriasis

• Short-contact therapy (apply-wait-wash) significantly improves tolerability and patient compliance compared to overnight regimens

• Effective steroid-sparing agent for long-term maintenance in localized plaque psoriasis

• Part of inpatient "Goeckerman regimen" (coal tar + UVB + anthralin) at specialized Indian dermatology centres

• Always counsel patients regarding inevitable skin and fabric staining before initiating therapy

• Apply petroleum jelly or zinc oxide paste to perilesional skin to protect from irritant spread

anthralin; dithranol; psoriasis; chronic plaque psoriasis; topical antipsoriatic; steroid-sparing; short-contact therapy; dermatology; paediatric psoriasis; alopecia areata off-label

RxIndia v1.0 — 05 May 2025

• CDSCO product information

• Indian Pharmacopoeia (IP)

• API Textbook of Medicine (Psoriasis chapter)

• IADVL Guidelines for the Management of Psoriasis in Adults (India)

• AIIMS Dermatology Unit Practice Protocols

• Goodman & Gilman's The Pharmacological Basis of Therapeutics (Dermatologic Drugs section)