Psoriasis - Topical Medications

Topical Vitamin D3 Analogs

A topical form of vitamin D3, calcipotriene (Dovonex), called calcipotriol in Europe, is proving to be both safe and effective. It is now available in a foam preparation, which makes compliance even easier. Several other topical vitamin D3 analogs, showing promise include maxacalcitol (Oxarol), tacalcitol, and calcitriol (Silkis), the active form of vitamin D.

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Benefits. Calcipotriene has the following benefits:

It appears to help block skin cell proliferation.
It enhances the maturity of keratinocytes (the impaired skin cell in psoriasis).
It has anti-inflammatory properties.

It is at least as effective as moderate topical corticosteroids, short contact anthralin, and coal tar in improving mild to moderate plaque psoriasis. Unlike steroids, patients do not develop thinning of the skin or tolerance to the drug.

Combinations. Combinations with other topical and oral treatments may improve effectiveness.

Calcipotriene is not as effective as the highest potency corticosteroids, but products or regimens that combine both agents are proving to be more effective than either agent alone. For example, an ointment that combines calcipotriene with betamethasone (Daivobet) may prove more effective than either agent alone.
Studies also report success in some patients who use vitamin D ointments in combination with the phototherapy treatment.
Combining vitamin D ointments with oral agents, notably methotrexate, acitretin, or cyclosporine, increases effectiveness and allows lower doses or either medication, thereby reducing side effects.

Side Effects. They include the following:

Calcipotriene causes skin irritation in about 20% of patients, particularly on the face and in skin folds. In fact, it causes greater skin irritation than potent corticosteroids. Diluting the drug with petrolatum or applying topical corticosteroids to sensitive areas may prevent this problem.
Although the drug appears to be safe and effective in children, there is some concern that it may lower levels of vitamin D to the extent that it could affect bone growth. More studies are needed to assess this effect.
There have been some reports of hypercalcemia (excessive levels of calcium in the blood) in some people who apply it to large areas.

Topical Retinoids

Retinoids are vitamin A derivatives and are being used for various skin disorders. Tazarotene (Tazorac) is the first topical retinoid found to be effective for mild to moderate psoriasis. It is available in cream or gel from.

Benefits. Tazarotene benefits the targeted skin tissue without causing the adverse systemic effects of oral retinoids. Also unlike steroids, patients do not develop thinning of the skin or tolerance to the drug. Only a very small amount is needed on each lesion. It can be used on the scalp and nails, but it is not recommended for the genital areas or around the eyes. The gel should be used on only 20% of the body at anytime, the cream on up to 35%. (As a way of measuring, the palm of the hand is about 1% of the body surface.)