Vitamin D Analogues for Psoriasis

Vitamin D analogues are popular for the local treatment of psoriasis.  The first compound approved in the U.S. was calcipotriene (brand name Dovonex) available as cream, ointment, and lotion (for the scalp) for twice daily application.  It was modestly effective but performed much better when combined with a topical corticosteroid.  Moreover, the ointment vehicle was more effective than the cream or lotion.  The manufacturer obliged by producing an ointment that combined calcipotriene with the medium-strength steroid betamethasone (brand name Taclonex),  allowing for the convenience of once daily application.  The combined product was more effective than either component used alone.  At the same time, Dovonex ointment, which is in Taclonex, was withdrawn from the marketplace while the weaker cream remained on the market.

Taclonex was also initially released as a topical suspension for the scalp.  It has an oily consistency which is desirable for massaging through hair into dry scaly skin.  The manufacturer, LEO Pharma, has now received FDA approval to market the suspension for once daily application to both scalp and body plaque psoriasis.

When the patent expired for the vitamin D analogue in Taclonex (calcipotriene), a generic ointment (Calcitrene) became available.  Sandoz has just released the first generic form of calcipotriene cream.  Sales for Dovonex cream for the last year were approximately $120 million.  We hope that these generic formulations of calcipotriene will be less expensive to consumers.

Another vitamin D ointment approved for psoriasis is Vectical made by Galderma.  It is calcitriol or vitamin D3.  The photograph accompanying this blog is from a clinical study I performed about 10 years ago comparing different concentrations of calcitriol against placebo cream to determine which worked best.

Recently, Stiefel introduced calcipotriene in a foam vehicle that melts and dries quickly on skin.  The brand is called Sorilux.  I predict this foam will be advantageous for use on psoriasis of the palms and hairy areas such as the scalp, where patients prefer not to feel a greasy or oily residue.

More About Dermatology and Society:
Cyclosporine, Psoriasis, and Grapefruit Juice
Gluten Sensitivity and Gluten-Free Diets in Dermatology

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2 Responses to Vitamin D Analogues for Psoriasis

  1. Melody Galka says:

    Dr. Camisa, what about oral Vitamin D3 treatment for Psoriasis?

    • DrCamisa says:

      I believe that vitamin D3 is necessary for normal skin, bone, and intestinal cells, and immune function, and I recommend that everyone take 2000 Units daily. People over 60 years should take 4000 Units daily. Higher doseages don’t seem to improve psoriasis when taken internally. That’s because vitamin D3 has to be metabolized by the liver then kidney before it becomes active in the body. This now active vitamin called calcitriol is effective for psoriasis as an ointment called Vectical which is safe to use, but the pill form is too toxic to take for psoriasis because it causes increased calcium levels in the blood and decreases kidney function.

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