Coal tar is a real treatment, and the evidence is better than its reputation.
The American Academy of Dermatology's psoriasis guidelines give it a Grade A recommendation. In head-to-head trials it is slower than modern treatments but statistically equivalent by twelve weeks.
And the mechanism has been properly worked out. Coal tar activates a receptor that restores filaggrin — a key barrier protein — and dampens inflammatory signalling. That research directly led to tapinarof, an FDA-approved prescription drug that works the same way. Coal tar is not folk medicine.
On the cancer question — the fear is largely misplaced. The definitive study followed 13,200 patients for a median of 21 years and found no increase in cancer. The scary classification applies to occupational exposure to coal-tar pitch in industry, not to therapeutic preparations.
It costs about $3.