Calcipotriene Ointment Research Articles

Epicutaneous sensitization with ovalbumin, staphylococcal enterotoxin B and vitamin D analogue induces atopic dermatitis in mice.

To illuminate a method for establishment of a cost-efficient atopic dermatitis (AD) mouse model by topical application of ovalbumin (OVA), super-antigen staphylococcal enterotoxin B (SEB), and calcipotriene ointment (CO) on the back of BALB/c mice. Methods: Experimental mice were topically treated with OVA/SEB or OVA/SEB/CO every other day during 15 days of induction. Clinical alterations on the skin area were monitored every other day. Epidermal thickness were measured by reflectance confocal microscope (RCM) before harvest. Inflammatory cells in skin biopsies were marked by hematoxylin-eosin (HE) staining. Blood sample and skin biopsies were measured by ELISA and quantitative real-time PCR to detect the expression of IL-2, IL-4, IL-31, interferon (IFN)-γ, tumor necrosis factor (TNF)-α pruritus-associated nerve growth factor (NGF), and serum IgE. Results: Human AD-like cutaneous local inflammatory reaction was characterized by the accumulation of inflammatory cells, increased epidermal thickness and serum IgE levels as well as Th1 cell-associated cytokines (IFN-γ, TNF-α), Th2 cell-associated cytokines (IL-4, IL-31), and NGF in the OVA/SEB/CO group compared with that in the normal control group or the OVA/SEB group. Conclusion: OVA/SEB/CO can induce an AD-like mouse model with lower economic and time consumption.

Comparative Efficacy of the Combination of Topical Betamethasone Dipropionate and Calcipotriene with Betamethasone Dipropionate and Calcipotriene Alone in the Treatment of Localized Vitiligo

Vitiligo is an acquired skin disorder characterized by welldefined white patches that are often symmetrically distributed. The study was conducted to compare the efficacy of the combination of topical betamethasone dipropionate and calcipotriene with betamethasone dipropionate and calcipotriene alone in the treatment of localized vitiligo. A clinical trial was carried out with the patients of vitiligo from January 2012 to August 2012. In group A, 20 patients were applied betamethasone dipropionate cream 0.05% and topical calcipotriene ointment (0.005%), in group B, 20 patients were applied betamethasone dipropionate cream 0.05% only; In group C, 20 patients were applied calcipotriene ointment 0.005% alone. From base line percentage reduction of total lesion in 1st follow up in group A, group B and group C were 20%, 15% and 10% respectively. At 3rd follow up in group A, group B and group C it was 50%, 37% and 30% and at 5th follow up, it was 80%, 75% and 65% respectively. ANOVA test was done and found significant difference of reduction of total lesion of vitiligo among the groups (p< 0.05). At the completion of the study, each patient was separately graded the treated sides on a 6-point ordinal scale based on a global estimate of the change in vitiligo and found that, the very much improvement were 70%, 55% and 45%, much improvement were 20%, 30% and 35% and improvement were 10%, 15% and 20% in group A, group B and group C respectively. ANOVA test was found significant difference of success rate of patients of localized vitiligo among the groups (p value 0.005). Both the drugs, calcipotriene and betamethasone dipropionate when used individually, were found to be equally effective in the treatment of vitiligo, but the combination of the two was found to be superior in efficacy. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21310 Medicine Today 2014 Vol.26(1): 31-35

Linear scleroderma in an adolescent woman treated with methotrexate and excimer laser

A 17-year-old Caucasian woman presented for evaluation and treatment of a tender expanding linear plaque on her left flank. Biopsy findings were consistent with morphea. Treatment initially included intralesional steroid injections and topical calcipotriene ointment, followed by methotrexate and excimer laser. The lesion decreased in size considerably with relief of symptomatic discomfort by 7 months. An excisional biopsy of a persistent eroded papule on the superior aspect of the morphea plaque revealed dermal thickening and sclerosis with superimposed perforation of a calcified nodule. Localized scleroderma, or morphea, is an autoimmune disease of the skin and underlying subcutaneous tissue primarily affecting the pediatric population. The excimer laser has been reported to effectively treat a variety of dermatologic conditions, including morphea. Its mechanism of action may be via depletion of T cells, altering apoptosis-mediating molecules and decreasing cytokine expression. Methotrexate is also useful for the acute and deep forms of morphea and has been shown to decrease levels of inter leukins-2 and -6, tenascin, and mast cells. This patient had a good clinical response with a combination of these two modalities. The epidermal perforation with transepidermal elimination of calcified necrotic collagen is a unique complication that may have been secondary to this combination treatment modality.

Compatibility Study Examining the Physical and Chemical Stability of Calcipotriene Ointment 0.005% with Three Topical Corticosteroids: Clobetasol Ointment 0.05%, Desoximetasone Ointment 0.25%, and Desoximetasone Ointment 0.05%

Combination topical therapy with calcipotriene ointment and topical corticosteroids is a useful treatment strategy for plaque psoriasis. Combination therapies involve using several drugs at once to optimize their effectiveness while potentially reducing unwanted adverse effects of the corticosteroid. Clobetasol propionate ointment 0.05% and desoximetasone ointment 0.25% are high-potency corticosteroids that are used for their anti-inflammatory and antipruritic properties in a variety of skin disorders. Calcipotriene ointment is a synthetic derivative of calcitriol, or vitamin D, used in the treatment of plaque psoriasis, but it can be inactivated by certain topical medications. Clinical trials involving the combination calcipotriene with topical corticosteroids have demonstrated clinical benefit compared with corticosteroid monotherapy. This study evaluated the physical and chemical compatibility of combination of topical therapies with a new, generic formulation of calcipotriene. Calcipotriene ointment 0.005% was compatible both physically and chemically when compounded with the high-potency topical corticosteroids clobetasol ointment 0.05% and desoximetasone ointment 0.25% and 0.05%.

Death of a dog caused by calcipotriene toxicity

Death of a dog caused by calcipotriene toxicity

Efficacy with calcipotriene and betamethasone dipropionate ointment in patients with moderate and severe psoriasis

Efficacy with calcipotriene and betamethasone dipropionate ointment in patients with moderate and severe psoriasis

Progressive Extragenital Lichen Sclerosus Successfully Treated With Narrowband UV-B Phototherapy

A 76-year-old woman with hypertension and hepatitis C presented with a 10-year history of sclerotic, atrophic, ivory-white plaques with violaceous borders on the upper part of her trunk and on her arms, waistline, and anogenital areas (Figure 1). The plaques were gradually extending and becoming more pruritic. A biopsy revealed findings diagnostic of lichen sclerosus (LS), including an atrophic epidermis, homogenized upper dermis, and sparse chronic inflammation in the middle dermis, below the homogenized collagen. The patient experienced a modest response to topical tacrolimus therapy, followed by more substantial improvement with topical clobetasol propionate therapy. However, several months later, she returned with worsening pruritus and enlargement of the plaques on her neck, waist, and arms. The anogenital lesions were stable. A trial of calcipotriene ointment applied to the midchest region did not produce any appreciable benefit.

A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: Short- and long-term outcomes

The merit of topical sequential therapy involving clobetasol foam and calcipotriene ointment has not been experimentally demonstrated. We sought to assess the short-term efficacy of twice-daily clobetasol foam plus calcipotriene ointment compared with either agent alone as monotherapy and to compare long-term use of weekday calcipotriene ointment with or without clobetasol foam weekend pulse therapy. Eighty-six subjects with plaque-type psoriasis received twice-daily treatment with clobetasol foam plus calcipotriene ointment or either agent as monotherapy for 2 weeks. Subjects in the combination group who achieved remission received weekday calcipotriene plus weekend pulse therapy with either clobetasol foam or vehicle for 6 months. After 2 weeks, psoriasis scores were significantly lower (P < .001) in the combination therapy group (adjusted trunk lesion score = 0.67) compared with monotherapy with either agent (lesion scores = 1.40 calcipotriene, 1.13 clobetasol foam). During the follow-up "weekday-weekend" phase, after 6 months, weekend pulse clobetasol foam was associated with a trend toward greater maintenance of remission compared with vehicle (92% improvement of trunk lesion vs 62%). Small sample size may have hampered the detection of statistical significance during long-term therapy. The combination of clobetasol foam and calcipotriene ointment is significantly more effective than monotherapy for short-term treatment. Weekday calcipotriene plus weekend pulse clobetasol foam shows a consistent trend toward greater maintenance of remission.

A multicenter study of calcipotriene ointment 0.005% and clobetasol propionate foam 0.05% in the sequential treatment of localized plaque-type psoriasis

A multicenter study of calcipotriene ointment 0.005% and clobetasol propionate foam 0.05% in the sequential treatment of localized plaque-type psoriasis

Book Reviews

A 40-year-old Hispanic man presented for treatment of dermatitis on his elbows and knees that had been evident for 5 years (Figure 1). He also had scaling plaques on his scalp. He had not been treated previously. He did not have any other medical problems and did not complain of arthritis. A clinical diagnosis was made of psoriasis and he was prescribed clobetasol propionate ointment with salicylic acid 6% in petrolatum that should be applied in the evening to his elbows and knees and calcipotriene ointment with clobetasol that should be applied in the morning. For his scalp, he was prescribed betamethasone valerate foam 0.12% to be applied directly to the scalp once a day and told to use a tar shampoo contain-ing 4% neutar solubilized coal tar extract (1.0% coal tar) three times a week. He followed this regimen for 2 weeks and the plaques became much less keratotic. He continued his scalp regimen. He then started using calcipotriene ointment and clobetasol propionate ointment together twice a day. Three weeks later the plaques were much flatter and less erythematous. The patient was instructed to apply clobetasol propionate to the affected areas twice a day on Saturday and Sunday and calcipotriene twice a day Monday through Friday. At this point, his scalp was almost clear and the patient was told touse the foam as necessary and to continue the shampoo.

Treatment Options for Psoriasis Part 1: Topical Treatments

A 40-year-old Hispanic man presented for treatment of dermatitis on his elbows and knees that had been evident for 5 years (Figure 1). He also had scaling plaques on his scalp. He had not been treated previously. He did not have any other medical problems and did not complain of arthritis. A clinical diagnosis was made of psoriasis and he was prescribed clobetasol propionate ointment with salicylic acid 6% in petrolatum that should be applied in the evening to his elbows and knees and calcipotriene ointment with clobetasol that should be applied in the morning. For his scalp, he was prescribed betamethasone valerate foam 0.12% to be applied directly to the scalp once a day and told to use a tar shampoo contain-ing 4% neutar solubilized coal tar extract (1.0% coal tar) three times a week. He followed this regimen for 2 weeks and the plaques became much less keratotic. He continued his scalp regimen. He then started using calcipotriene ointment and clobetasol propionate ointment together twice a day. Three weeks later the plaques were much flatter and less erythematous. The patient was instructed to apply clobetasol propionate to the affected areas twice a day on Saturday and Sunday and calcipotriene twice a day Monday through Friday. At this point, his scalp was almost clear and the patient was told touse the foam as necessary and to continue the shampoo.

A highly effective once daily treatment with a new two-compound calcipotriene/betamethasone dipropionate ointment in psoriasis vulgaris

The present study-a multicentre, prospective, randomised, partly double-blind 3 arm parallel group study-evaluated the efficacy and safety of two different treatment regimes using the two-compound product (calcipotriene 50 mcg/g and betamethasone dipropionate 0.5 mg/g), and calcipotriene ointment after 8 weeks treatment.

Retrospective analysis of the treatment of psoriasis of the palms and soles

In this retrospective analysis, the effect of currently used treatments in 26 patients with psoriasis of the palms and soles were analyzed. In general, patients are treated initially with topical medications including superpotent topical corticosteroids in combination with calcipotriene ointment or tazarotene gel or both. If satisfactory improvement is not achieved in 4–8 weeks, systemic retinoids are added, formerly etretinate and currently acitretin, except in women of childbearing potential. If the latter regimen is not effective within two months, soak PUVA is added to the regimen of oral retinoids and topical medications. If improvement is inadequate, or if the treatment regimen is not tolerated, methotrexate or cyclosporine have been added in the past. The availability of the excimer laser has recently modified our approach so that this therapy is used in combination with acitretin before soak PUVA. With the availability of biologic agents, methotrexate is avoided because of its hepatotoxicity and bone marrow toxicity and cyclosporine is avoided because of its nephrotoxicity. If oral acitretin plus topical therapy is not adequate to control the disease and the excimer laser is not an option because of its limited availability, alefacept, etanercept and infliximab are added when possible. Other biologic agents are likely to be added to this list in the future.

Combination of calcipotriene (Dovonex) ointment and tazarotene (Tazorac) gel versus clobetasol ointment in the treatment of plaque psoriasis: A pilot study

Background: Both calcipotriene and tazarotene have been shown to be effective in the treatment of psoriasis. No study has evaluated the effect of using both agents simultaneously. Objective: Our purpose was to evaluate the effectiveness of combination treatment of psoriasis with calcipotriene ointment and tazarotene gel by comparing them with clobetasol ointment, a class I topical corticosteroid. A secondary objective was to evaluate the clinical compatibility of applying both agents at the same time. Methods: This pilot study was a prospective, single-center, open-label, right/left comparison of 28 lesion pairs in 15 patients. It consisted of a 2-week treatment phase, followed by a 4-week post-treatment observation phase. Results: All 15 patients completed the treatment phase of the study. At the end of the active treatment phase (end of week 2), calcipotriene- and tazarotene-treated lesions showed nearly identical reductions in scaling (P = .93), plaque elevation (P = .76), and overall lesional severity scores (P = .29) compared with their matched clobetasol-treated counterparts. Erythema improved significantly more in clobetasol-treated lesions (P < .05) during the treatment period, but differences became statistically insignificant during the post-treatment period (;P = .20). No patients had significant irritation from the treatments. During the post-treatment phase (weeks 3-6), all lesions worsened; plaque elevation returned somewhat more rapidly in calcipotriene- and tazarotene-treated lesions (P < .01), whereas changes in scaling, erythema, and overall lesional severity were not significantly different between the two treatment groups (P > .05). Conclusion: The nonsteroid combination of twice-daily calcipotriene ointment and once-daily tazarotene gel was not statistically different from twice-daily application of the class I corticosteroid clobetasol ointment in reducing psoriatic scaling, plaque elevation, and overall lesional severity over a 2-week period. There does not seem to be any chemical incompatibility between calcipotriene ointment and tazarotene gel that is clinically significant. (J Am Acad Dermatol 2002;46:907-13.)

Denileukin Diftitox for the Treatment of Panniculitic Lymphoma

A 24-year-old white woman presented with a 9-month history of proximal extremity nodules, associated with fevers and arthralgias, that had only a partial response to a combination of oral prednisone, topical betamethasone ointment, and topical calcipotriene ointment. Examination revealed a healthy-appearing woman with a low-grade fever. There were annular and polycyclic eroded plaques and firm subcutaneous nodules on her proximal arms and dusky red, atrophic plaques on her right thigh and the middle of her back (Figure 1A). Laboratory evaluation revealed a microcytic anemia (hemoglobin, 11.2 g/dL; mean corpuscular volume, 77 fL) and normal liver function test results. Results of several skin biopsies showed histological and immunophenotypic features of subcutaneous panniculitic T-cell lymphoma (Figure 2A and B). A positron emission tomographic scan showed multiple foci of intense fludeoxyglucose F 18 uptake superficially within the upper extremities and proximal right lower extremity consistent with the cutaneous T-cell malignancy, without extracutaneous disease (Figure 3A). She initially responded to bexarotene (Targretin; LigandPharmaceuticals Inc,SanDiego,Calif) (150mg/d)and interferonalfa(1.8 10 U,3timesweekly).However,within 2 months of initiating these therapies, her disease had progressed rapidly with an increase in size, number, and degree of infiltration of the lesions and worsening of her constitutional symptomswith increased fatigueand low-grade fevers. She was prescribed prednisone (15 mg/d orally).

Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: Effects on the duration of improvement

Background: Weekend therapy with superpotent topical corticosteroids has been used for the long-term treatment of psoriasis. Recently, calcipotriene ointment has been added to this regimen for use on weekdays, but there are no long-term studies of that combination. Objective: The purpose of this study was to determine whether the addition of weekday calcipotriene to a pulse therapy regimen of weekend superpotent corticosteroids results in a longer duration of remission of plaque psoriasis. Subjects: This was a double-blind, placebo-controlled, parallel-group study. Forty-four patients with mild to moderate psoriasis were treated with calcipotriene ointment in the morning and halobetasol ointment in the evening for 2 weeks. Thereafter, 40 patients who were at least moderately (50% or greater) improved were randomized to 2 treatment groups. After 2 weeks of treatment with calcipotriene ointment in the morning and halobetasol ointment in the evening, 20 patients were randomized to receive halobetasol ointment twice daily on weekends and calcipotriene ointment twice daily on weekdays, and 20 patients were randomized to receive halobetasol ointment twice daily on weekends and placebo ointment twice daily on weekdays. Results: Seventy-six percent of patients applying halobetasol ointments on weekends and calcipotriene ointment on weekdays were able to maintain remission for 6 months compared with 40% of patients applying halobetasol ointment on weekends only with the vehicle on weekdays. Conclusion: The addition of calcipotriene ointment applied on weekdays to a weekend pulse therapy regimen of superpotent corticosteroids can increase the duration of remission of psoriasis. (J Am Acad Dermatol 1998;39:447-50.)

Topical calcipotriene for morphea/linear scleroderma

Background: Morphea and linear scleroderma are characterized by erythema, induration, telangiectasia, and dyspigmentation. There is no universally effective treatment. Oral calcitriol has been beneficial in the treatment of localized and extensive morphea/scleroderma, but the use of topical calcipotriene has not been reported. Objective: The purpose of this study was to evaluate the efficacy and safety of topical calcipotriene 0.005% ointment in the treatment of localized scleroderma. Methods: In a 3-month open-label study, 12 patients aged 12 to 38 years with biopsy-documented active morphea or linear scleroderma applied calcipotriene ointment under occlusion twice daily to plaques for 3 months. The condition of each patient had previously failed to respond to potent topical corticosteroids and, for some patients, systemic medications. Efficacy was assessed at baseline, 1 month, and 3 months. Levels of serum ionized calcium, intact parathyroid hormone, and 1,25-dihydroxyvitamin D and of random urinary calcium excretion were measured. Results: During the 3-month trial, the condition of all 12 patients showed statistically significant improvement in all studied features. No adverse effects were reported or detected through laboratory monitoring of mineral metabolism. Conclusion: Topical calcipotriene 0.005% ointment may be an effective treatment for localized scleroderma, but double-blind placebo controlled studies are needed for confirmation. (J Am Acad Dermatol 1998;39:211-5.)

Interactions between calcipotriene and ultraviolet light

Background: Calcipotriene is often used with UVB or PUVA, but interactions between UV radiation and calcipotriene have not been examined extensively. Objective: Our purpose was to examine interactions between calcipotriene and UV light. Methods: Minimal erythema doses (MEDs) were determined with UVB and immediate pigment darkening was measured for UVA. The effect of calcipotriene ointment applied before phototesting was examined. Thick and thin applications of calcipotriene were compared. Calcipotriene ointment was applied to a small area on the skin before phototherapy. Patients received either UVB, PUVA, UVA, or no phototherapy. After phototherapy, the ointment was collected and assayed by reverse-phase, high-performance liquid chromatography. Results: MEDs for UVB and immediate pigment darkening for UVA were unaffected by calcipotriene. Thick application of calcipotriene, however, increased the MED. UVA caused substantial reductions in the concentration of detectable calcipotriene. Conclusion: When used in conjunction with PUVA, calcipotriene should be applied after exposure to UVA. (J Am Acad Dermatol 1997; 37:93–5.)

Calcipotriene Ointment Applied Once a Day for Psoriasis: A Double-Blind, Multicenter, Placebo-Controlled Study

Clinical experience with calcipotriene has shown its efficacy in the treatment of psoriasis, both alone1-5and in combination with other agents. This double-blind, placebo-controlled study was designed to provide clinical experience in the United States with once-daily treatment of plaque-type psoriasis with 0.005% calcipotriene ointment. Patients and Methods. Two hundred thirty-five otherwise healthy nonpregnant patients, aged 18 to 86 years (mean, 45.1 years), with stable plaque-type psoriasis covering 5% to 20% of skin surface and showing plaque elevation of at least 4 on a 9-point scale, were entered into a randomized, double-blind, clinical trial of 0.005% calcipotriene ointment applied once a day for 8 weeks. Scaling, erythema, plaque elevation, and physician's global assessment were scored on a 9-point scale. Patients were evaluated at baseline and at weeks 1, 2, 4, 6, and 8 of treatment (Figure 1). Results. Forty percent of patients treated with the active drug and 2.2%

A multicenter trial of calcipotriene ointment and halobetasol ointment compared with either agent alone for the treatment of psoriasis

Calcipotriene, a vitamin D3 analogue, inhibits cell proliferation and induces cell differentiation in vitro. 1, 2 Many studies have shown that calcipotriene ointment (0.005%) is effective in the treatment of plaque psoriasis. 3, 4 The purpose of this three-axrn trial was to evaluate the efficacy and safety of calcipotriene ointment 0.005% applied in the morning and halobetasol propionate 0.05% ointment applied in the evening versus calcipotriene ointment applied twice daily versus halobetasol propionate ointment applied twice daily for moderate plaque psoriasis.