Topical Vitamin D Analogues Treatment For Psoriasis

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Topical Vitamin D Analogues Treatment For Psoriasis

Three vitamin D analogues are available in the UK for topical treatment of psoriasis, namely calcipotriol, calcitriol and tacalcitol.

Calcipotriol

Calcipotriol is available in ointment and cream formulations containing calcipotriol at the concentration of 50 microg/g, and as a scalp lotion (50 microg/ml). Treatment may be used once or twice daily. Improvement usually becomes apparent within 2 weeks, and continues for at least 8 weeks, at which point some patients are clear but the majority reach a plateau. In the latter case, the improvement can often be maintained by continuing treatment. Calcipotriol is safe, provided that the manufacturer's recommendations are followed and the maximum dose 100g/week for adults, 75g for children over 12 and 50g for children of 6-12 years is not exceeded. Use in children under 6 is not recommended. Calcipotriol is more convenient to use than tar or dithranol and does not produce the side effects of topical corticosteroids However, self limiting, irritant reactions are common.. Calcipotriol has become one of the first-line treatments for psoriasis vulgaris.

Efficacy of Topical Vitamin D Analogues Treatment For Psoriasis

Calcipotriol is an effective treatment for mild to moderate chronic plaque psoriasis, more so than calcitriol, tacalcitol, coal tar, and short contact dithranol. Only potent topical corticosteroids seem to have comparable efficacy at eight weeks. Although calcipotriol causes more skin irritation than topical corticosteroids this has to be balanced against the potential long term effects of corticosteroids. Skin irritation rarely led to withdrawal of calcipotriol treatment.

Use in pregnancy: Although calcipotriol is not believed to be teratogenic, there is little experience of its use in pregnancy.

Safety and side effects

Calcipotriol is irritant and may give rise to redness, soreness or pruritus in around 20% of patients during 6 weeks of treatment. Such reactions are particularly common when the face is inadvertently contaminated with medication. This is self-limiting but occasionally necessitates a break in treatment. This irritancy largely precludes the use of calcipotriol on the face. Flexures are also vulnerable. The maximum recommended rate of usage is 100g of ointment weekly. This should not be exceeded, as there is a risk of vitamin D intoxication.

When doses below 100g weekly have been used, no evidence of any effect has been observed. However, at 100g weekly a small increase in urine calcium excretion is detectable. When the dose rate is increased to 200g or 300g weekly, both urine and serum calcium levels rise, and serum parathyroid hormone is depressed. There are now a number of reports of individual patients in whom hypercalcaemia has developed when the maximum recommended dose rate has been exceeded. Absorption of the vitamin D analogue may be higher in erythrodermic psoriasis, and hypercalcaemia has been reported in such a case when 200g of ointment were applied in 7 days. In another erythrodermic patient, hypercalcaemia developed when using 100g of ointment weekly, and recurred when the treatment was reintroduced at a lower dose rate. There have been four reports of probable sensitisation to calcipotriol. Experience has not lead to concern over the risk of psoriasis rebounding after topical calcipotriol, in a manner similar to that said to occur with topical corticosteroids.

Patient acceptability of Topical Vitamin D Analogues Treatment For Psoriasis

Calcipotriol is an improvement on previously existing topical treatments for psoriasis, except for those patients who use emollients alone. Compared to dithranol, it is less irritant, less messy and more convenient. Patients' opinions regarding the acceptability of these treatments have been directly compared in a large trial: calcipotriol was considered more acceptable. It is less messy than tar, and is free from the odour of tar, which some patients dislike. Calcipotriol is free from the side effects of topical corticosteroids, which are a source of concern to patients. Calcipotriol is often irritant. Although this is a disadvantage, it is only occasionally necessary for treatment to be discontinued as a result.

Synergy of Topical Vitamin D Analogues Treatment For Psoriasis with other treatments

Published data suggest that there is a useful additive effect when calcipotriol is used in conjunction with PUVA, cyclosporin, and UVB. It would appear possible that the use of calcipotriol may allow a useful dose sparing effect with UVB phototherapy or PUVA, and systemic treatments, and thus reduce their toxicity, but more research is required to address this question.

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Diprolene AF : This medication is used to treat swelling, inflammation, or itching of skin conditions such as eczema, dermatitis, rashes, insect bites, poison ivy, allergies and other irritations.

Dovonex : This medication is a form of vitamin D. It is used on the skin to treat psoriasis.

Elidel : Pimecrolimus is used to treat certain skin conditions such as eczema (atopic dermatitis), in people who have not responded well to, or who should not use other eczema medications (e.g., topical steroids). Atopic dermatitis is an allergic-type condition that causes red, irritated, and itchy skin.

Kenalog : This medication is used to treat swelling, inflammation, or itching of skin conditions such as eczema, dermatitis, rashes, insect bites, poison ivy, allergies and other irritations.

Lamisil : This medication is an antifungal used on the skin to treat skin infections such as athlete's foot, jock itch or ringworm.

Protopic : This medicine is an immunosuppressant used topically to treat itching and swelling associated with a certain skin condition (atopic dermatitis).

Selsun : This medication is used to treat dandruff; a certain scalp infection (seborrheic dermatitis); and for a condition that discolors the skin (tinea versicolor).

Synalar : This medication is used to treat swelling, inflammation, or itching of skin conditions such as eczema, dermatitis, rashes, insect bites, poison ivy, allergies and other irritations.

Ultravate : This medication is used to treat swelling, inflammation, or itching of skin conditions such as eczema, dermatitis, rashes, insect bites, poison ivy, allergies and other irritations.

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