This protocol addresses patients with severe or recalcitrant psoriasis — disease that is extensive, significantly impairs quality of life, or has not responded adequately to standard measures.
Goeckerman therapy is a well-established option for this population. Developed in 1921, it combines coal tar application with UVB phototherapy and has a long safety record in patients with severe or recalcitrant disease.
This protocol centres on a coal tar–based phototherapy combination — topical coal tar applied to affected sites before targeted UVB exposure. An alternative pathway involves a structured program of supervised natural sun exposure at a specialised climatotherapy site.
The complete regimen, including sequencing, application details, session structure, and all clinical decision points, is available in the full protocol below.
Goeckerman therapy is a psoriasis treatment that was developed in 1921 and involves the use of coal tar in combination with UVB phototherapy. It is a safe and effective option for patients with severe or recalcitrant psoriasis.
There is sufficient evidence to recommend the use of Goeckerman for the treatment of psoriasis.
The original regimen called for the application of 1% to 5% crude coal tar to affected skin sites, allowing 30 minutes to 2 hours before wiping or washing it off and subsequently exposing the treated site to UVB light. Treatments were carried out 5 days per week.
There is sufficient evidence to recommend the use of climatotherapy for the treatment of psoriasis.
Most of the patients received climatotherapy at the Dead Sea for a period of 4 weeks (mean, 4.1 weeks), and by the end of treatment, 94% had achieved PASI 75 and 73% had achieved a 95% improvement in PASI score.
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