Goeckerman Therapy and Ingram Regimen for Psoriasis

Goeckerman [GEK-er-man] therapy or the Ingram regimen may be prescribed to treat severe psoriasis. While neither is widely available, a few hospitals and psoriasis treatment centers in the United States offer this type of treatment.

Number of treatments: Goeckerman and Ingram are effective at clearing psoriasis, but both require intensive treatment for several hours a day in a psoriasis clinic or hospital. Treatment is usually given Monday through Friday. Patients must undergo daily treatment for several weeks. Most patients receive treatment for 3, 4, or 5 weeks.

Goeckerman therapy typically involves receiving ultraviolet (UV) light treatment and applying a prescription coal tar mixture to the psoriasis. The coal tar mixture usually remains on the skin for several hours.

Ingram regimen involves a similar process. Instead of coal tar, a psoriasis medicine called anthralin (which comes from coal tar) is applied to the skin. After receiving a UVB or UVA light treatment, the anthralin is applied. Sometimes, the body is wrapped in a plastic dressing. The anthralin usually remains on the skin for 2 to 4 hours.

Goeckerman therapy may be combined with Ingram regimen or another light treatment. When Goeckerman is combined with Ingram, the patient receives UVB phototherapy and both coal tar and anthralin are applied to the skin. These usually remain on the skin for a few hours or longer. This treatment is repeated Monday through Friday for several weeks. Some claim that no treatment for severe psoriasis works faster, has fewer side effects, and offers longer periods of clearing than the Goeckerman/Ingram combination.

How long clearing lasts: Goeckerman therapy tends to offer the longest remission time for moderate to severe psoriasis. The average remission time for treatment with Goeckerman therapy is 6 to 12 months. For the Ingram regimen, the average remission time is about 6 months.

Side effects: Red and tender skin that often looks like a sunburn, burning skin, freckling, and premature skin aging (age spots, wrinkles, sagging skin) can develop. This intensive treatment also may increase a person’s risk of developing skin cancer.

With the Ingram regimen, the pores in the skin can clog and cause a breakout that looks like acne.

References:
Koo J, Lebwohl M. “Duration of remission of psoriasis therapies.” Journal of the American Academy of Dermatology July 1999; 41: 51-9.

Lebwohl M, Ali S. “Treatment of psoriasis. Part 1. Topical therapy and phototherapy.” Journal of the American Academy of Dermatology October 2001; 45: 487-98; quiz 99-502.

Menter A, Korman NJ, Elmets CA et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy.” Journal of the American Academy of Dermatology January 2010; 62: 114-35.

Serrao R, Davis MD. “Goeckerman treatment for remission of psoriasis refractory to biologic therapy.” Journal of the American Academy of Dermatology February 2009; 60: 348-9.

Zanolli  MD, Feldman SR, Clark AR, et al. 2000. “Phototherapy Treatment Protocols.” New York, NY: Parthenon Publishing Group.  
 

All content solely developed by the American Academy of Dermatology

 

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.

 

A recent study found that Goeckerman therapy can be effective when psoriasis does not respond to one or more of the biologics.

 
 

 

 

 

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