Vitamin D analogues in the treatment of psoriasis

• calcipotriol and tacalcitol are topical vitamin D analogues which inhibit keratinocyte proliferation and induce terminal differentiation
• trials show calcipotriol to be as effective as dithranol
• topical vitamin D analogues are often the first line treatment for psoriasis in primary care
• topical vitamin D analogues can cause local irritation and excessive use can lead to hypercalcaemia (1) - has led to the use of combinations of vitamin D analogues with other topical therapies, UV phototherapy and systemic therapies
• a systematic review found that in head-to-head comparisons of vitamin D against potent or very potent corticosteroids there were no significant differences. However, combined treatment with vitamin D /corticosteroid performed significantly better than either vitamin D alone or corticosteroid alone (1)

A suggested protocol for the use of topical preparations in psoriasis is presented in the linked item.

Reference:

1. Prescriber (2005); 16 (8).
2. Prescribers' Journal (1993);33(5): 183-91.
3. Mason AR, Mason J, Cork M, Dooley G, Edwards G. Topical treatments for chronic plaque psoriasis.Cochrane Database Syst Rev. 2009 Apr 15;(2):CD005028.