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Dithranol has been used to treat psoriasis for many years, and was traditionally applied by nurses in a hospital ward. Modern dithranol preparations mean that people are able to use it themselves at home, although it can be time-consuming and messy.
What is dithranol?
Dithranol has been used in the treatment of psoriasis since the nineteenth century. It is thought to have anti-inflammatory properties, and also slows down the over-production of skin cells, which is a problem in psoriasis.
Dithranol treatments are topical (applied to skin) and come in the form of an ointment, available in the lower strength 0.1% Dithrocream at pharmacies until the autumn 2022, or via a special order prescription only. It can be an effective treatment for some if used correctly, with no significant long-term side effects.
When should dithranol treatments be used?
Dithranol can irritate skin that does not have psoriasis on it, so it is most appropriate for well-defined plaques of psoriasis on the limbs or torso.
You should not use dithranol treatments on sensitive areas of the body, such as the face, genitals or skin folds, unless specifically told to by a doctor.
How should dithranol be used?
Dithranol should always be started with the lowest strength treatment. Increased strengths can be introduced gradually if needed, unless an irritation occurs. The cream or ointment should usually be applied to psoriasis once a day for anywhere between ten minutes and an hour before being washed off. The length of time will depend on how your doctor has advised you, or what is stated on the treatment’s patient information leaflet.
In most cases, dithranol should be used every day until the skin is clear. At this point, some staining may be left on the skin, but areas where psoriasis once was should feel the same as normal skin when touched. This can take up to six weeks. If clearance isn’t seen in four to six weeks, it could be that a higher strength of dithranol is needed. The highest strengths of Dithrocream were discontinued in May 2021, and so any further increase in strength would only be available via a special order prescription.
It is thought that ‘active’ topical treatments, including dithranol, work better when the skin is well moisturised. Therefore, it is recommended that an emollient (moisturiser) should be applied and allowed to sink in before using a dithranol treatment.
Dithranol is a time consuming treatment, and so is not suitable for everyone. However, it can be an effective treatment for those who wish to use it.
What are the side effects of dithranol?
Some mild skin irritation is common in the areas the dithranol has been applied to. If you experience burning or soreness that does not get better, stop treatment and consult your doctor. In many cases, using a lower strength treatment helps to improve side effects.
Be aware that the treated areas of skin may gradually become stained purple or brown. This is harmless and will gradually disappear after the end of treatment. Do not attempt to scrub the colour from the skin, as this may damage the skin and make psoriasis worse. Staining of the skin in the centre of the plaques of psoriasis is common when the psoriasis is starting to clear.
Tips for using dithranol treatments
- Don’t forget that dithranol stains skin, fabrics and surfaces. Wear plastic disposable gloves when applying the treatment, and use old and dark coloured clothes, pyjamas and bedsheets. A little bleach usually helps to remove staining from ceramic bathroom tiles.
- It can be helpful to time the dithranol application so that you are ready to rinse it off around the time that you would usually have a bath or shower.
- Dithranol must only be applied to the plaques of psoriasis, as it can irritate non-psoriatic skin. Some people find that applying a border of petroleum jelly (such as Vaseline) around the psoriasis border helps to prevent the dithranol touching areas that it shouldn’t.
- Dithranol can be used on the scalp. Firstly, comb hair to remove loose scales and, after parting, rub the cream well into the affected areas of the scalp. Remove cream by shampooing the hair after and try to avoid the rinse water going into the eyes. Blonde or fair hair may take on a pinkish tinge, but this will grow out after the treatment.
For information on the different types of dithranol treatments available to treat psoriasis, take a look at our dithranol information sheet.