Psoriasis calcipotriol

Topical therapy is the initial drug treatment strategy for patients with mild to moderate psoriasis. It is estimated that approximately 70% to 80% of all patients with psoriasis can he treated adequately with use of topical therapy.1 Topical therapies include corticosteroids, coal tar products, anthralin, vitamin D3 analogues such as calcipotriol, retinoids such as tazarotene, and topical immunomodulators such as tacrolimus and pime-crolimus.18 Vitamin D3 analogues and topical retinoids all affect keratinocyte functions and the immune response. Currently, these are in wider use than is either anthralin or coal tar preparations. 

Vitamin D analogues (calcipotriol, calcitriol, and tacalcitol) are also frequently selected as initial pharmacotherapy in the management of mild to moderate psoriasis.2 These inhibit keratinocyte differentiation and proliferation and maybe antiinflammatory.2 Unlike corticosteroids, tachyphylaxis does not occur with prolonged use. Clearance of lesions should occur after 4 to 6 weeks of treatment.2 Lack of response by 8 weeks... 

Calcipotriol is a vitamin D derivative used topically for psoriasis. It does not cause skin discoloration and does not stain clothes. 

Eczema is managed by emollients and topical corticosteroids. Fatty cream base is an emollient and is therefore indicated in eczema. Podophyllum is used in warts, lidocaine is an anaesthetic, calcipotriol is used in psoriasis and... 

Kreuter A, Sommer A, Hyun J, Brautigam M, Brockmeyer NH, Altmeyer P, Gambichler T. (2006) 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone in the treatment of intertriginous psoriasis A double-blind, randomized controlled study. Arch Dermatol 142 1138-1143. 

Calcipotriol, a vitamin D derivative without vitamin D activity is used to treat psoriasis. 

Calcipotriol is a vitamin D3 derivative which is used as a topical agent in the treatment of psoriasis. Although not completely elucidated its mechanism of action seems to be based on inhibition of the proliferation and stimulation of the differentiation of epidermal keratinocytes. Adverse effects include irritation of the skin but also urticarial reactions. Calcipotriol has 100 fold less vitamin D activity as its active vitamin D3 metabolite calcitriol. However, calcipotriol in overdose can cause symptoms of hypercalcemia. 

Kawahara C, Okada Y, Tanikawa T, Fukusima A, H, Tanaka Y. Severe hypercalcemia and hypernatremia associated with calcipotriol for treatment of psoriasis. J Bone Miner Metab 2004 22 159-62. 

Two vitamin D derivatives, calcipotriol and tacalcitol (Figure 5.107) are widely used in the topical treatment of psoriasis, to inhibit the cell proliferation characteristic of this condition. 

The major risk resulting from topical treatment of psoriasis with salicylic acid is the potential chronic or acute systemic intoxication with the symptoms of burning of oral mucosa, frontal headache, CNS symptoms, pH deviation (metabolic acidosis), tinnitus, nausea, vomiting, and gastric symptoms.28-30 These symptoms may occur in topical treatment of large body surfaces, especially in children.31-33 Even lethal cases have been reported.34,35 Therefore, a concentration higher than 10%, and an application on larger surfaces especially in children are not suitable. Salicylic acid should not be applied to more than 20% of the body surface area.13 It should be noted that some topical treatments of psoriasis such as calcipotriol are inactivated by salicylic acid.36... 

RCTs it is therefore possible to gain information about the efficacy of moisturizers as monotherapy. The effect of the cream base varies. In a stable, dry, and scaly dermatosis such as psoriasis, active treatment with calcipotriol reduces disease severity as assessed by PASI scores by 56%, whereas the use of the cream base reduces it 35%.1 Dry skin is also a key diagnostic element in atopic dermatitis and moisturizers are therefore extensively used in this disease. Looking at the placebo-arm in RCTs of topical treatment of atopic dermatitis the placebo effect appears to be in the range of 20%.2 6 The disease is however also more dynamic, and it waxes and wanes more frequently than psoriasis, which may explain the difference seen between the two disseases. 

Dubertet, L., Wallach, D., Souteyrand, P. et al. Efficacy and safety of calcipotriol (MC903) ointment in psoriasis vulgaris. A randomized, bouble-blind, right/left comparative, vehicle-controlled study. J. Am. 

Topical vitamin D analogs as calcipotriol, and tacalcitol are well established, effective and safe preparations for the treatment of psoriasis vulgaris due to their antiproliferative and prodifferentiating effects on keratinocytes.110 They can be used either as monotherapy or in combination with other treatment modalities.111 The main side effect is the increasing risk ofhypercalcaemia with increasing amounts of vitamin D analogs applied to the skin. 

Medicines related to vitamin D are also effective but an unwanted side effect of the early ones was to cause the body to retain too much calcium, which is detrimental. More than 1500 different compounds have been synthesised to try and find one that would act on the psoriasis without raising the level of calcium in the blood. Calcipotriol cream was the one that performed best and is now widely used. Another chemical, etretinate, was introduced in 1975 and found to be just as effective. It was eventually superseded by acitretin when it was discovered that the body converted etretinate to acitretin and it was the latter which was the active agent. Acitretin is now the prescribed drug and it is very effective with three quarters of those treated reporting noticeable improvement and for about a third of patients their psoriasis cleared up completely. Psoriasis can also be treated with successive oral doses of methoxsalen followed by UV irradiation of the affected area. 

Ultraviolet B light is effective in guttate psoriasis and potentiates the effects of topical agents such as calcipotriol and dithranol. A psoralen followed by ultraviolet light (PUVA) is used in severe cases (see Psoralens, p. 306). 

Calcipotriol and tacalcitol are vitamin D analogues available as creams or ointments for the treatment of psoriasis (p. 313). 

Topical calcipotriol (a vitamin D analogue) is an effective and safe treatment for mild to moderate psoriasis vulgaris. Its mode of action is identical to that of 1,25-dihydroxycolecalciferol (calcitriol). 

Calcipotriol can occasionally convert psoriasis vulgaris into pustular psoriasis (SEDA-19,165). 

Berth-Jones J, Bourke JF, Iqbal SJ, Hutchinson PE. Urine calcium excretion during treatment of psoriasis with topical calcipotriol. Br J Dermatol 1993 129(4) 411-14. 

Russell S, Young MJ. Hypercalcaemia during treatment of psoriasis with calcipotriol. Br J Dermatol 1994 130(6) 795-6. 

Bourke JF, Mumford R, Whittaker P, Iqbal SJ, Le Van LW, Trevellyan A, Hutchinson PE. The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis. J Am Acad Dermatol 1997 37(6) 929-34. 

Molin L. Topical calcipotriol combined with phototherapy for psoriasis. The results of two randomized trials and a review of the literature. Calcipotriol-UVB Study Group. Dermatology 1999 198 375-381. 

A general limitation for systemic application of l,25(OH)2D3 is its calcemic side-effects. Therefore, topical application, e.g. by calcipotriol, a significantly less calcemic analog of l,25(OH)2D3, is used for the treatment of psoriasis so far [47,179-182]. The... 

Tham SN, Lun KC, Cheong WK. 1994. A comparative study of calcipotriol ointment and tar in chronic plaque psoriasis. BrJ Dermatol 131(5) 673-677. 

Calcipotriol is a vitamin D analogue. Its use in psoriasis came about relatively recently following the observation that an oral vitamin D derivative used for osteoporosis coincidentally seemed to improve psoriasis. 

The mode of action of calcipotriol in psoriasis is apparently unconnected to the role of vitamin D in calcium metabolism. 

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