Beyond Psoriasis: What Non-Psoriatic Skin Conditions Can Calcipotriol Treat?

🔍 Key Finding

Topical calcipotriol is a safe and effective treatment for a variety of skin diseases beyond psoriasis, including actinic keratosis, alopecia areata, hand eczema, lichen planus and sclerosus, seborrheic dermatitis and keratosis, and vitiligo, and may be underutilized as a steroid-sparing agent. Dermatologists may want to consider calcipotriol as an alternative or adjuvant topical therapy, especially before considering more aggressive treatments.

🔬 Methodology Overview

• Design: Narrative review.
• Data Sources: Published literature.
• Selection Criteria: Studies examining the use of calcipotriol for non-psoriatic dermatological diseases.
• Analysis Approach: Qualitative synthesis of study findings.
• Scope: Topical calcipotriol use in various skin conditions beyond psoriasis, including efficacy, safety, and comparison with other treatments.

📊 Results

Here are the key findings from the provided research article on the non-psoriatic uses of calcipotriol:

• Actinic Keratoses (AKs): Mixed results. One small study (N = 9) showed a significant decrease in AKs with twice-daily calcipotriol cream for 12 weeks. Another study on renal transplant recipients (N = 13) found no benefit. A larger RCT (N = 132) showed the combination of calcipotriol/5-FU was significantly more effective than 5-FU/Vaseline in reducing AK counts (87.8 % vs. 26.3 % reduction on the face, for example). A 3-year follow-up (N = 84) of this latter study showed a reduced risk of squamous cell carcinoma on the face and scalp in the calcipotriol/5-FU group.
• Alopecia Areata (AA): Variable efficacy. Retrospective study (N = 48) showed > 75 % hair regrowth in 62.5 % of patients treated with twice-daily calcipotriol cream for 12 weeks. Another prospective study (N = 22) showed hair regrowth in 59.1 % of patients with the same regimen. Combining calcipotriol with mometasone 0.1 % cream showed greater improvement than mometasone alone in an RCT (N = 100).
• Hand Eczema: A double-blind RCT (N = 13) found calcipotriol ointment to be as effective as desoximetasone ointment in reducing hand eczema severity after 8 weeks of twice-daily treatment.
• Lichen Planus: Limited evidence. An open pilot trial (N = 16) showed complete clearing in 31.25 % and partial response in 25 % of patients treated with topical calcipotriol and hydroxyzine for 3 months.
• Seborrheic Dermatitis: Conflicting results. A small pilot study (N = 10) suggested potential benefit, while a larger RCT (N = 40) found calcipotriol inferior to vehicle control. Another RCT (N = 60) found calcipotriol inferior to betamethasone.
• Vitiligo: Often used as adjunctive therapy. Limited efficacy as monotherapy in some studies. Several studies suggest improved repigmentation when combined with PUVA or NB-UVB, although other studies have shown no added benefit compared to light therapy alone.
• Other Dermatoses: Case reports and small studies suggest potential benefit in various other conditions, but further research is needed. These include acanthoma, acanthosis nigricans, and several others.

💡 Clinical Impact

Topical calcipotriol is a safe and effective therapy for various dermatologic conditions beyond psoriasis, potentially underutilized as a steroid-sparing agent. Dermatologists should consider calcipotriol as an alternative or adjunctive treatment, especially in cases requiring steroid-sparing approaches.

🤔 Limitations

• Small sample sizes in many studies
• Mixed results across different studies for some conditions
• Limited long-term data for some conditions
• Potential for local skin irritation, burning, pruritus, edema, and erythema
• Rare but potential systemic side effects like hypercalcemia and parathyroid hormone suppression with high doses
• Pregnancy category C, with some studies showing skeletal abnormalities in animals at high doses
• Potential for lack of response in some individuals, especially with monotherapy for conditions like alopecia areata and vitiligo

✨ What It Means For You

Dermatologists should consider topical calcipotriol as a safe and effective alternative or adjunctive therapy for various skin diseases, potentially reducing the need for stronger medications like topical steroids. This review highlights calcipotriol’s efficacy in treating conditions beyond psoriasis, including actinic keratosis, alopecia areata, vitiligo, and lichen sclerosus, expanding treatment options and promoting a steroid-sparing approach.

Reference

Patel RT, Gay JJ, Fagan KK, Eikenberg JD. Non-psoriatic uses of calcipotriol: a concise updated review. Dermatology Online Journal. 2023;29(3):1. https://doi.org/10.5070/D329361422