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Topical Management of Psoriasis and the Role of Vitamin D3 Analogues

Topical Management of Psoriasis and the Role of Vitamin D3 Analogues 1

Calcitriol is a natural topical vitamin D3 analog with both short- and long-term studies demonstrating its efficacy and safety, with minimal risk of side effects. Nevertheless, despite the therapeutic importance of topical corticosteroids in the treatment of psoriasis, it is important that clinicians modify their use and incorporate other therapeutic approaches to reduce side effects and optimize efficacy. The efficacy of topical treatment with vitamin D analogs in psoriasis can also be increased by combination with other therapies: tumor necrosis factor (TNF )-inhibitors, methotrexate (MTX), low dose oral cyclosporine (2 mg/kg/day), oral acitretin, topical dithranol, topical steroids. Numerous topical and systemic therapies are available for the treatment of the cutaneous manifestations of psoriasis. Combining a corticosteroid and vitamin D analog may offer additional benefit;

Topical Management of Psoriasis and the Role of Vitamin D3 Analogues 2Treatment for psoriasis aims to clear the plaques as much as possible. Psoriasis is caused by cells in the outer layer of your skin multiplying faster than normal. Calcipotriol (INN) or calcipotriene (USAN) is a synthetic derivative of calcitriol, a form of vitamin D. It is used in the treatment of psoriasis, marketed under the trade name Dovonex in the United States, Daivonex outside of North America, and Psorcutan in Germany. T cells are known to play a role in psoriasis, and it is thought that the binding of calcipotriol to the VDR modulates the T cells gene transcription of cell differentiation and proliferation related genes. Topical vitamin D3 and low-calcemic analogs induce thymic stromal lymphopoietin in mouse keratinocytes and trigger an atopic dermatitis. Long-term corticosteroid monotherapy is not recommended for this purpose because of the potential for adverse events (AEs). 3-6 This article provides a perspective on the role of topical vitamin D analogue and corticosteroid combination treatment as long-term maintenance therapy.

To optimize the topical treatment of psoriasis in Saudi Arabia, the Saudi Society of Dermatology and Dermatologic surgery (SSDDS) have initiated a project to develop guidelines for the management of psoriasis. Recently, however, vitamin D analogs, a new anthralin preparation and topical retinoids have expanded physicians’ therapeutic armamentarium. Potential local side effects of topical corticosteroid therapy include acne and localized hypertrichosis. First topical retinoid indicated by the FDA for treatment of psoriasis. Systemic side effects when applied continuously to extensive psoriasis (for example more than 10 of body surface area affected).

Calcipotriol For Psoriasis. Side Effects; Dosage Of Calcipotriol

To minimize side effects and to increase effectiveness, topical corticosteroids are generally used on active outbreaks until they’re under control. These synthetic forms of vitamin D slow down the growth of skin cells. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that may be used alone to treat mild to moderate psoriasis or in combination with other topical medications or phototherapy. A newer type of psoriasis treatment, narrow band UVB therapy may be more effective than broadband UVB treatment. Today, topical calcipotriol, a vitamin D analog, is used safely and effectively in the treatment of psoriasis without the systemic effects described above. Almost everyone with psoriasis will try topical treatments and some people will use them throughout their lifetime, so it is important to know how effective and safe they are, said lead author Anne Mason, a research fellow at the Centre for Health Economics the University of York, in England. Using the two products separately, vitamin D in the morning and corticosteroid at night, can achieve similar effects, and be as well tolerated, as using a specially combined product. D analogues and thinning of the skin that is an adverse effect of long-term corticosteroid use, he said.

Adopted Guidelines Of Care For The Topical Management Of Psoriasis From American And German Guidelines