Studies show some of the chemicals in coal tar may cause cancer, but only in very high concentrations, such as in what is used in industrial paving. Anyone using tar regularly should follow a regular skin cancer checkup schedule. California requires OTC coal tar shampoos, lotions and creams that contain more than percent coal tar to be labeled with cancer warnings. However, the FDA maintains that OTC products with coal tar concentrations between percent and 5 percent are safe and effective for psoriasis, and there is no scientific evidence that the tar in OTC products is carcinogenic.
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Other combination therapies may lack convenience but are also effective. In the patient with comedones and inflammatory lesions, a comedolytic agent such as tretinoin, adapalene or azelaic acid may be combined with benzoyl peroxide or a topical antibiotic. The combination of clindamycin and tretinoin causes less irritation than tretinoin alone. 30 In using tretinoin and the benzoyl peroxide–erythromycin combination together, the patient should alternate the products daily for two weeks to minimize irritation. When agents that cause irritation are used, patience is necessary, but the results may be well worth the wait.