Calcipotriene (calcipotriol) is a synthetic vitamin D3 derivative that is useful for
the treatment of patients with moderate plaque psoriasis. Its effects are comparable
with those of class II topical steroids, without the associated adverse effects.
Its mechanism of action involves both induction of terminal differentiation of
keratinocytes and inhibition of keratinocyte production. It should be applied to
the face with care, as this region is more susceptible to irritation, burning, and
itching, as seen in approximately 10% of patients. Other adverse effects include
erythema, peeling, xerosis, dermatitis, or worsening psoriasis in 1% to 10% of
patients. Fewer than 1% of patients experience hypercalcemia, atrophy, hyperpigmentation,
or folliculitis. Allergic contact dermatitis to calcipotriene has been
reported.
Most patients demonstrate improvement after 2 weeks; 70% of patients
improve after 8 weeks, with 10% showing complete clearing. It should be avoided
in patients with documented impairment in calcium metabolism, hypercalcemia,
vitamin D toxicity, or history of renal stones.
Calcipotriene may be used as an adjuvant with psoralens plus ultraviolet A
(PUVA) and ultraviolet B (UVB). Pretreatment with or subsequent addition of calcipotriol
to PUVA reduces the cumulative doses of UVA needed to achieve >75%
reduction in severity and distribution of psoriasis.
