🔍 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

• 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.