Calcipotriol

What is calcipotriol?

Calcipotriol is a vitamin-D derivative, about 1% as powerful as the natural hormone calcitriol (also known as 1,25 dihydroxycholecalciferol).

Known as calcipotriene (Dovonex®) in the United States, calcipotriol is available as an ointment, cream and scalp solution at a concentration of 50µg/g. In New Zealand, it is called Daivonex®, and, from 1 July 2016, only the ointment is marketed. Calcipotriol is not available in tablet or injection form.

Calcipotriol is also available in combination with betamethasone propionate as a gel or ointment (Daivobet®) and foam (Enstilar®).

What is calcipotriol used for?

Calcipotriol is a prescription medication used mainly for psoriasis. It is moderately or very effective for about 80% of patients. This means the patches become less scaly and thick, but red patches often persist despite continued treatment.

It should be applied to the affected patches of psoriasis twice daily and can be used safely long term. The ointment is used on trunk and limbs. The cream is more often used in the body folds or on the face and ears. The scalp solution is used in hairy areas.

Psoriasis pre-calcipotriol

Psoriasis post-calcipotriol

Calcipotriol is sometimes also helpful in the following skin conditions:

• Morphoea
• Palmoplantar pustulosis
• Ichthyosis
• Palmoplantar keratoderma
• Grover disease
• Disseminated superficial porokeratosis and linear porokeratosis
• Benign familial pemphigus
• Pityriasis rubra pilaris
• Acanthosis nigricans
• Epidermal naevus.

How does calcipotriol work?

Calcipotriol acts like vitamin D. It is antiproliferative, reducing the abnormal proliferation of keratinocytes that occurs in psoriasis, and it induces cell differentiation, normalising epidermal growth.

What are the side effects of topical calcipotriol?

Topical calcipotriol is usually well tolerated. Side effects are more common with the ointment formulation than with the cream (but the ointment is more effective on plaque psoriasis).

• It may sting or cause an irritant dermatitis (dry itchy rash) on facial skin: use very cautiously in psoriasis affecting this area. When used on other sites, wash hands carefully to reduce the chance of inadvertent application to the face.
• Treated psoriasis may develop peeling around the edge of the plaques.
• Surrounding skin may be irritated i.e. become red, dry and itchy.
• About 1% is absorbed through the skin. An overdose (more than 100g/week) could have an effect on calcium metabolism. If large doses are necessary, calcium levels in blood and urine should be monitored.

Caution

Keep calcipotriol away from your dog: it is very poisonous and may be fatal if eaten by a dog.

Combined treatment

Calcipotriol is often used with other treatments for psoriasis with good effect. 

Topical steroids

Calcipotriol may reduce the skin thinning effect of topical steroids.

• A fixed combination of calcipotriol and betamethasone dipropionate gel/ointment or foam is applied once or twice daily
• Alternatively, calcipotriol may be used once daily and a topical steroid applied 12 hours later. This allows the physician to choose a moderate potency or mild topical steroid.
• Calcipotriol may be used twice daily Monday to Friday, and the topical steroid twice daily at weekends. This may be a safer regime.

Salicylic acid

Salicylic acid is used to remove scale but as it deactivates calcipotriol, it should not be applied at the same time. If combined use is required, apply them at a different time of day.

Ultraviolet radiation

Ultraviolet radiation (UVR) deactivates calcipotriol, which could also act as a sunscreen, so the calcipotriol should be applied after UVR and not beforehand.

Acitretin

Some patients find calcipotriol more irritating when they are on acitretin because acitretin thins the skin and make it more sensitive. Use moisturisers and emollients regularly.

Methotrexate

No special precautions are necessary with the combination of calcipotriol with methotrexate.