Skin Health Psoriasis Treatment What to Know About Anthralin Cream or Shampoo Uses and Side Effects of the Original Psoriasis Treatment By Dean Goodless, MD Updated on August 14, 2022 Medically reviewed by William Truswell, MD Print Table of Contents View All Table of Contents Uses Before Treatment Dosage Side Effects Warnings and Interactions Other Drug Classes Anthralin cream is one of the original psoriasis topical medications. First introduced in 1916, it was applied to the skin as a thick paste to treat severe plaque psoriasis. While effective, anthralin was extremely messy and rarely used outside out of a hospital setting. Newer incarnations of the drug are more user-friendly but still present challenges in terms of messiness, staining, and the duration of treatment. Even beyond convenience, intensive therapies like anthralin have fallen to the wayside in favor of more bioactive topical drugs, including hydrocortisone cream, tazarotene, and topical vitamin D derivatives. Nevertheless, anthralin still has a place in treatment if other topical medications prove either ineffective or intolerable. Tatiana / Getty Images Topical Drugs Used to Treat Psoriasis Uses Anthralin, classified as an anthracene derivative, is typically used for the treatment of stable plaque psoriasis in adults. It appears to inhibit DNA replication and slow the hyperproduction of the skin cells that can lead to the formation of skin plaques. Anthralin is intended for use on the torso, arms, legs, and scalp. It should not be used on the face or genitals. Anthralin is available by prescription in either cream, gel, or shampoo formulations. The products vary in strength from 0.1% to 2% and are sold in the United States under the following brand names: DrithocremDritho-ScalpPsoriatecZithranol, Zithranol-RR Anthralin has a slower mechanism of action than topical corticosteroids used to treat psoriasis and may take several weeks before improvement is seen. With that being said, it is less likely to cause steroid withdrawal or skin atrophy (thinning) that commonly occurs with long-term corticosteroid use. Moreover, because anthralin does not utilize liver enzymes for metabolization, it is less likely to competitively interact with medications that do, including biologic drugs like Tremfya (guselkumab) and Consentyx (secukinumab). How Plaque Psoriasis Is Treated Before Treatment Generally speaking, anthralin is not used unless other standard remedies have failed to provide relief. It is not considered an effective response for severe psoriatic flares but is used when chronic plaque psoriasis is either stable or dormant. Precautions and Considerations Safety research on using Anthralin during pregnancy is limited, but the drug may be warranted despite the possible risks. It is unknown what, if any, harm may be caused by using the drug during breastfeeding. Speak with your healthcare provider if you are pregnant or are planning to get pregnant so that you are fully appraised of the pros and cons of treatment. There is little known about the risk of anthralin cream in younger children. Given the risk of side effects, anthralin is rarely, if ever, used in kids under 12. Dosage Anthralin dosage varies by the drug formulation and symptoms. Always read the product instructions carefully before use, and call your healthcare provider or pharmacist if you are unsure how to use the drug. For mild to moderate psoriasis, a 1% cream or shampoo is generally prescribed. Milder formulations may be used for children 12 and over, while stronger formulations may be prescribed for hard-to-treat lesions on the feet or hands. How to Apply To avoid irritation, anthralin is usually applied for shorter periods of time when first starting treatment. As your body adapts to the medication, the duration will gradually be increased as tolerated. For the treatment of psoriatic skin plaques: Apply a thin layer of anthralin cream once daily to the lesions only. (To prevent irritating surrounding skin, apply a protective layer of petroleum jelly around each lesion.)Leave on the skin for five to 10 minutes when first starting treatment.After that time, rinse the skin with lukewarm water and wash with soap.After a week, gradually increase the duration until you reach a maximum of 30 minutes per application. For the topical treatment of scalp psoriasis: Wash or rinse your hair and towel dry.Apply a thin layer of cream to the lesions once daily while the hair is still damp.Leave for five to 10 minutes when first starting.Rinse the scalp with lukewarm water and shampoo.After a week, gradually increase the duration until you reach a maximum of 30 minutes. For treating scalp psoriasis with anthralin shampoo: Lightly rinse and damp dry your hair.Carefully massage the shampoo into your scalp three to four times weekly. (To protect the surrounding skin, apply petroleum jelly around the hairline and ears and the back of the neck.)Leave for 20 to 30 minutes.Rinse with lukewarm water and wash with a mild regular shampoo.After a week, gradually increase the duration until you reach a maximum of 60 minutes. Some people will massage anthralin shampoo into the scalp and leave it overnight covered with a shower cap. Ask your dermatologist if this is an appropriate option for you. How to Store Anthralin cream, gel, or shampoo can usually be stored at room temperature (between 59 and 86 degrees F). Zithronol needs to be stored at a slightly cooler temperature (between 68 and 77 degrees F). Keep the product in a dark, cool room in its original container well away from direct sunlight. Always check the expiration date before application and discard the medication after the use-by date. Side Effects Anthralin may cause mild skin irritation when treatment is first started, although this usually resolves with ongoing use. The bigger concern is staining. Anthralin can temporarily stain the skin a yellowy-brown and permanently stain clothing fabrics, towels, and bathmats. It can even leave permanent stains on ceramic basins and countertops if not cleaned up immediately. To avoid staining, wear disposable gloves when applying anthralin. Rinse the skin or hair as thoroughly as you can before drying. Have paper towels and a spray cleaner nearby in case of spills. Warnings and Interactions There are no known drug interactions associated with anthralin cream, gel, or shampoo. With that being said, always advise your healthcare provider about any medications you are taking, whether they are topical or oral, prescription or over the counter, therapeutic or recreational. Any drug that causes skin irritation may compound that caused by anthralin. Even high-dose antioxidant supplements have been known to potentiate the effects of anthralin and cause inflammation at the application site. The only absolute contraindication for anthralin use is a known allergy to anthralin or any of the ingredients in the product. Psoriasis Other Drug Classes There are other drugs that temper the hyperproduction of skin cells in a way similar to anthralin. These include: Coal tar, classified a keratolytic agent Tazarac (tazarotene), a topical retinoid As with anthralin, their exact mechanisms of action are unknown. Coal tar is an attractive option because it can be purchased over the counter and has few side effects. Tazarac, available by prescription, also has few side effects and can be used on an ongoing basis, including on the face. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Torsekar R, Gautam MM. Topical therapies in psoriasis. Indian Dermatol Online J. 2017;8(4):235-245. doi:10.4103/2229-5178.209622 Fathalla D, Youssef EMK, Soliman GM. Liposomal and ethosomal gels for the topical delivery of anthralin: preparation, comparative evaluation and clinical assessment in psoriatic patients. Pharmaceutics. 2020;12(5):446. doi:10.3390/pharmaceuticals12050446 Barnes L, Kaya G, Rollason V. Topical corticosteroid-induced skin atrophy: a comprehensive review. Drug Saf. 2015;38(5):493-509. doi:10.1007/s40264-015-0287-7 Elorac, Inc. Zithranol shampoo (label). Painsi C, Patscheider M, Inzinger M, Lange-Asschenfeldt B, Quehenberger F, Wolf P. Patient perspectives on treating psoriasis with classic inpatient dithranol therapy: a retrospective patient survey: Dithranol therapy. J Dtsch Dermatol Ges. 2015;13(11):1156-1163. doi:10.1111/ddg.12820 Menter A, Cordoro KM, Davis DMR, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020;82(1):161-201. doi:10.1016/j.jaad.2019.08.049 Sehgal VN, Verma P, Khurana A. Anthralin/dithranol in dermatology: Anthralin/dithranol. Int J Dermatol. 2014;53(10):e449-e460. doi:10.1111/j.1365-4632.2012.05611.x Tanghetti E, Lebwohl M, Stein Gold L. Tazarotene revisited: safety and efficacy in plaque psoriasis and its emerging role in treatment strategy. J Drugs Dermatol. 2018;17(12):1280-1287. Additional Reading Ashton, R. and Whitefield, M. Anthralin: Historical and current perspectives. J Am Acad Dermatol. 1983 Aug;9(2):173-92. doi:10.1016/S0190-9622(83)70125-8 Holstein, J.; Fehrenbacher, B.; Bruck, J. et al. Anthralin modulates the expression pattern of cytokeratins and antimicrobial peptides by psoriatic keratinocytes. J Dermatol Sci. 2017 Sept;87(3):236-45. doi:10.1016/j.jdermsci.2017.06.007 Physician's Desk Reference. (2019) Anthralin - Drug Summary. 2019 Physicians' Desk Reference (73rd Edition). Whippany, New Jersey: PDR Network. By Dean Goodless, MD Dean R. Goodless, MD, is a board-certified dermatologist specializing in psoriasis. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit