Mail (Sep-Oct, 1998)

T/Gel Overnight
from John F.

I just happened across your web pages and find them very informative. Of particular interest was the talk about the Scalp Cocktail. I found it interesting because of a similar experience that I had.

About 4 years ago, I developed psoriasis on my scalp. It started as a small patch, then spread until it covered about 70% of my scalp. Very annoying. I tried a number of the OTC shampoos, but nothing helped. I went to a doctor that prescribed Nizoral shampoo. That didn't help any either. The psoriasis was there for months. I then thought, "All of the OTC shampoos have tar, so tar must really have some benefit to it." I went out and bought some "T/Sal" by Neutrogena. (This T/Sal was actually made with tar and salicylic acid.) I also figured that just a simple shampooing didn't leave the tar on long enough to be effective. So at night, I shampooed with the T/Sal, but didn't wash it off. I laid a towel on my pillow, and slept with the T/Sal on my hair. The next morning, my scalp felt different after washing the shampoo out. So I did this a couple more times and sure enough within about 2 weeks, the psoriasis was at least 95% gone!

I was very happy. I had two tiny spots of it left (one above each ear). The thing that is interesting is that this T/Sal was made with tar. It was dark in color, due to the tar, but also had the salicylic acid. After using up that one bottle, I could never find the stuff again. They've gone to making T/Sal without the tar, and T/Gel without the salicylic acid. I still have these two stubborn spots that won't go away.

This is what I presently do which works fairly well. I pick off all of the flakes that I can. Then, I apply the T/Gel shampoo straight to the scalp and rub it in a bit. This is full-strength, no water. I do this before I go to sleep. I put a towel over my pillow, and go to sleep. In the morning, I shampoo using the T/Gel. About 2 days later, I get a heavy layer of flakes that comes off very easily, almost like shedding a thick layer of skin. Underneath, the skin feels very free of psoriasis, and doesn't flake at all for 4 days or more. I haven't been diligent enough to try this out for 3 or 4 days in a row though, but maybe soon.

I'd really like to get my hands on some of that T/Sal with the tar in it. I've mixed the T/Sal and the T/Gel, but I think I end up with a diluted mixture (one dose tar, one dose salicylic acid, two doses filler ... instead of the original T/Sal which had one dose tar, one dose salicylic acid, one dose filler). I'd be interested in hearing the results of someone else trying this method out.

That original T/Sal really worked wonders for me. I think the combination of that T/Sal, plus leaving it on overnight, really did the trick. I'm very fortunate that my psoriasis is now only limited to two patches on my scalp. I'd be interested in hearing also if this method works on someone's arms, legs, or wherever.

Granted, Neutrogena says "Don't use this for more than 3 days a week" or something like that, but I did it anyway and it worked pretty well for me. Thanks for providing the web pages. -John


Ed's Response: Neutrogena T/Gel "Extra Strength" is my fall-back when I can't find Pentrax, which is 90% of the time around here. I've not used any shampoo as an overnight dressing because the compounded Scalp Cocktail (i.e., made by a pharmacist, not manufactured) serves that purpose for me and does not have the "other stuff" shampoo has in it—the stuff that makes suds and supposedly loosens dirt, etc. I used to wonder why Neutrogena didn't combine the /Sal and /Gel products since both salicylic acid and the tar extract seemed to help, but then I read this brief article in the NPF Pharmacy News, March 1994. (I'm sure they won't mind my reproducing it here.)

If you have scalp psoriasis and use Neutrogena T/Gel Therapeutic Shampoo and Neutrogena T/Sal Therapeutic Shampoo (antipsoriatic shampoos that contain two different active ingredients), you may have considered mixing the two shampoos in one bottle for convenience. Makes sense, right? Wrong! Don't do it.

According to Mitchell Wortzman, Ph.D., president of Neutrogena Dermatologics, mixing the two shampoos will result in inactivating one of them. Dr. Wortzman says the active ingredients in the two shampoos, salicylic acid and Neutar (a coal tar extract), are not "pH" compatible. The salicylic acid, which softens the skin and helps remove scales, needs a more acid environment than the Neutar, which slows psoriatic cells from rising to the surface. So when the two are mixed, the salicylic acid won't work.

Instead of two therapeutic actions in one shampoo, you'll get one therapeutic action for the price of two. Which is no bargain. "Don't think you can save time and get the benefit of both," says Wortzman. "But if you shampoo with one, rinse, and then shampoo with the other, you'll be fine." You can also use the two shampoos on alternating days.

Evidently, that "pH incompatibility" has been overcome in the compounded Scalp Cocktail, because it does contain both a tar extract and salicylic acid.

I would be hesitant to leave either T/ product on my scalp overnight because of the other ingredients; however, I sometimes let it stand for an hour or more in the morning. I doubt whether the chemical effects are persistent because it dries. Occluding it, like I occlude the scalp cocktail, under a shower cap, hence keeping it moist all night, might result in my scalp peeling off along with the shower cap in the morning! But that doesn't sound too bad on second thought. I could polish my skull to a fine sheen, adapt to the baldness, and forget about scalp psoriasis. Couldn't I? Stay in touch, John ... and be careful! -Ed

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