What is calcipotriene

Calcipotriene also known as calcipotriol, is a vitamin-D derivative that is used to treat psoriasis (a skin disease in which red, scaly patches form due to increased production of skin cells on some areas of the body). Calcipotriene is in a class of medications called synthetic vitamin D3 derivatives. Calcipotriene works by slowing the excessive production of skin cells.

Calcipotriene comes as a cream to apply to the skin and as a solution (liquid) to apply to the scalp. The cream and solution are usually applied two times a day. Use calcipotriene at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use calcipotriene exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. DO NOT apply calcipotriene topical to your face.

Calcipotriene controls psoriasis but does not cure it. You may see some improvement in your condition after 2 weeks, but it may take up to 8 weeks before you feel the full benefit of calcipotriene.

Calcipotriene solution may catch fire. Do not use this medication near heat or an open flame, such as a cigarette.

To use calcipotriene cream, follow these steps:

1. Wash your hands.
2. Apply a thin layer of cream to the area to be treated. Be careful not to get the cream on your face, especially in or near your eyes.
3. Rub the cream into the skin until it disappears.
4. Wash your hands.

To use calcipotriene solution, follow these steps:

1. Wash your hands.
2. Comb hair to remove any unattached psoriasis scales.
3. Make a part in your hair near the affected areas.
4. Apply a small amount of the solution to the lesions. Be careful not to get the solution on your forehead or other areas of your face, especially in or near your eyes, nose, or mouth.
5. Rub the solution into the lesion gently.
6. Wash your hands.

How does calcipotriol work?

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

Calcipotriene special precautions

Before using calcipotriene:

• tell your doctor and pharmacist if you are allergic to calcipotriene, or any other medications.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had any medical conditions.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking calcipotriene, call your doctor.
• plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing (such as a hat), sunglasses, and sunscreen. Calcipotriene may make your skin sensitive to sunlight.

Caution

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

Calcipotriene uses

Calcipotriene is a prescription medication used mainly for psoriasis. Calcipotriene 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.

Calcipotriene 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 face and ears. The scalp solution is used in hairy areas.

Calcipotriene 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 nevus.

Calcipotriene combined treatment

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

Topical steroids

Calcipotriene may reduce the skin thinning effect of topical steroids.

• A fixed combination of calcipotriene and betamethasone diproprionate (trade name Daivobet®) gel/ointment/foam is applied once or twice daily
• Alternatively, calcipotriene 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.
• Calcipotriene 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 calcipotriene, they 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 calcipotriene, which could also act as a sunscreen, so the calcipotriene should be applied after UVR and not beforehand.

Acitretin

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

Methotrexate

• No special precautions are necessary with the combination of calcipotriene with methotrexate.

Calcipotriene side effects

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

• Calcipotriene 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.

Calcipotriene may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• itching
• redness
• worsening of psoriasis
• burning
• stinging or tingling of skin
• dry skin

Some side effects can be serious. If you experience these symptoms, call your doctor immediately:

• rash
• irritation of the treated or nearby area of skin

Calcipotriene may cause other side effects. Call your doctor if you have any unusual problems while taking calcipotriene or if your symptoms get worse.