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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Calcitriol (Silkis), calcipotriol (Dovonex) and tacalcitol (Curatoderm) are vitamin D3 analogues which are the first line treatment for psoriasis (see p. 166). They decrease epidermal proliferation and are effective in flattening the psoriatic plaques and removing the scale but not so good at getting rid of the redness. Only calcitriol and tacalcitol can be used on the face and flexures. Calcipotriol can cause redness and irritation at these sites and occasionally elsewhere. They do not cause hypercalcaemia and hypercalcuria since less than 1% applied to the skin is absorbed.
Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Regarding the management of psoriasis in pregnancy, which one of the following statements is true? a Calcipotriol is recommended as first line treatment.b Topical steroids may be teratogenic.c Ultraviolet B (UVB) therapy is the safest systemic treatment.d Both men and women should avoid methotrexate for 1 month preconceptually.e In women retinoids should be avoided for 6 months preconceptually.
Calcipotriol
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Calcipotriol is a synthetic vitamin D derivative usually formulated for topical dermatological use as antipsoriatic. It competes with vitamin D for vitamin D-receptors in regulating cell proliferation and differentiation. Calcipotriol thereby induces differentiation and suppresses proliferation of keratinocytes, reversing abnormal keratinocyte changes in psoriasis, and leads to normalization of epidermal growth. It is indicated as monotherapy or in a combination product with betamethasone dipropionate for the treatment of moderate plaque psoriasis. In pharmaceutical products, calcipotriol is usually employed as calcipotriol monohydrate (CAS number 147657-22-5, EC number not available, molecular formula C27H42O4) (1).
Long-term topical management of psoriasis: the road ahead
Published in Journal of Dermatological Treatment, 2022
Siegfried Segaert, Piergiacomo Calzavara-Pinton, Pablo de la Cueva, Ahmad Jalili, Dominique Lons Danic, Andrew E. Pink, Diamant Thaçi, Melinda Gooderham
Once-daily treatment regimens are often preferred for induction therapy (49), with less frequent (once- or twice-weekly) application during maintenance treatment. Current German guidelines state that, if used for long-term management, calcipotriol should be given once or twice daily for up to 1 year; however, the guidelines acknowledge that the majority of evidence for the use of calcipotriol is short term (11). UK guidelines state that if once-daily topical preparations would improve adherence in those patients for whom twice-daily potent corticosteroids or coal tar preparations are indicated, a combined product containing calcipotriol and betamethasone dipropionate should be offered and applied once daily for up to 4 weeks (8). Topical long-term management with the application of two-compound products once or twice a week after initial therapy was recommended more recently in Germany (14).
Perspectives on the pharmacological management of psoriasis in pediatric and adolescent patients
Published in Expert Review of Clinical Pharmacology, 2021
Emmanuel Mahé, Maud Amy De La Bretêque, Céline Phan
Vitamin D3 analogues inhibit epidermal proliferation and promote keratinocyte differentiation. Calcipotriol has been evaluated in a controlled trial in children aged 2–14 years: PASI was reduced by 52% in the treated group and by 37% in the control group [34]. Calcipotriol is licensed for use in children, with maximum doses of 50 g/week for children aged over 6 years and 75 g/week for children aged over 12 years. To be effective, a 1–2-month treatment is usually required. Calcipotriol can also be applied to flexural skin to reduce the risk of developing striae distensae when these areas are being treated with steroids. As with topical steroids, calcipotriol can be proposed as a proactive weekend therapy for patients with lesions that always reoccur at the same location [1,21]. The main side effect associated with calcipotriol is local irritation.
Topical calcipotriol plus betamethasone dipropionate for the treatment of plaque psoriasis: a drug evaluation
Published in Expert Opinion on Pharmacotherapy, 2021
Caitlin G. Purvis, Esther A. Balogh, Courtney E. Heron, Steven R. Feldman
Calcipotriol (1,25-dihydroxyvitamin D3) is a synthetic calcitriol analog and the most active metabolite of vitamin D3 (see drug summary box). Vitamin D3 analogs’ mechanism is not entirely understood in the treatment of psoriasis. This molecule binds to the vitamin D3 receptor (VDR), a steroid receptor found within most cells of the body, including activated T cells, keratinocytes, and melanocytes [26]. Binding of the VDR promotes heterodimerization with the retinoid X receptor-α (RXR), which inhibits or activates gene transcription [27,28]. This reduces CD8(+) and interleukin (IL)-17(+) T cells, dampening the action of the inflammatory cascade, a contributor to the pathogenesis of psoriasis [12,26,27]. Overall, this effect normalizes keratinocyte differentiation and proliferation, restores the granular layer, and regulates steps in the immune response [10,12].