Table 1.

Modified Goeckerman Regimen for Psoriasis Treatment, Detailing Cool-Down Procedures, Phototherapy, Tar Application Protocols, Daily Monitoring, and Discharge and Maintenance Plans

Cool Down Procedure*
	Topical corticosteroids application:
	- Trunk/Extremities: Triamcinolone 0.1% ointment
	- Face/Axillae/Groin: Hydrocortisone 2.5% cream
	- Scalp: Clobetasol 0.05% lotion
	- Highly inflamed areas: Clobetasol 0.05% ointment
	Occlusion:
	- Trunk/Extremities: Cling film
	- Hands: Impermeable gloves
	- Feet: Shower caps inside socks
	- Scalp: Shower cap
Phototherapy and Tar	The patient should shower daily before phototherapy sessions.
	Set up a treatment room with plastic wrap, socks, UV eye protection, and gowns
	Decide on initial phototherapy dose using the Fitzpatrick skin type (Table 2) and increase the phototherapy dose based on patient response.
	Post-phototherapy, apply crude coal tar (CCT) in Aquaphor to affected areas. If CCT is not available, then an alternative type of tar or topical steroid under occlusion can be used.
	For scalp involvement, apply 4% tar shampoo or 20% liquid carbonis detergens (LCD) in Nutraderm.
	Start with the lowest CCT strength (2%), and increase strength as tolerated by the patient (up to 5%).
Weekend Protocol:	As the phototherapy center is closed, instruct the patient to use 10% CCT in the morning and Mometasone cream/ointment at night.
Daily Monitoring	Assess the patient’s skin daily for sensations of burning, which can indicate the patient’s inability to tolerate light therapy, or worsening itch, which can indicate irritation from the tar, light, or plastic wrap.
	Decrease phototherapy dose if any adverse reactions are detected.
	Continue the therapy for two weeks, then plan discharge.
Discharge and Maintenance	Prescribe topical medications: Triamcinolone cream/ointment (twice daily for body), Clobetasol with or without vitamin D analog for recalcitrant lesions (twice daily), and 20% LCD in Aquaphor to the body (once daily), and 20% LCD in Nutraderm to the scalp (once daily).
	If able, schedule for outpatient phototherapy 1–3x/week for at least one month (preferably 2–3 months).
Follow-Up:	Schedule a physician appointment within 1–2 months post-discharge for monitoring.

Notes: *If necessary, ask patient to do remotely at home for two weeks before the start of the program, as well as up to the first five days of the program, depending on the level of erythema.