Calcitriol 3 microg/g ointment: an effective and safe addition to the armamentarium in topical psoriasis therapy

High-potency topical corticosteroids are very effective for the treatment of psoriasis, but are associated with a number of cutaneous adverse effects. Vitamin D modulators have emerged as an important alternative to corticosteroids for the long-term topical treatment of psoriasis. Calcitriol 3 microg/g ointment has long been used to treat psoriasis in Europe and is now the only vitamin D3 ointment available for use in the United States (U.S.). Several randomized clinical trials have compared the safety, efficacy, and cosmetic acceptability of calcitriol ointment with other topical psoriasis therapies. In a three-week investigator-blinded study of 25 healthy subjects, calcitriol 3microg/g ointment was associated with markedly less cumulative skin irritation than was calcipotriene ointment. A multicenter, investigator-blinded study of patients with psoriasis found that investigator-rated global improvement of psoriasis symptoms with calcitriol ointment was statistically noninferior to calcipotriene ointment and that calcitriol use produced significantly fewer patients with cutaneous reactions or discomfort. A multicenter clinical trial of patients with psoriasis who had lesions affecting sensitive skin areas found that calcitriol use produced less skin irritation than did calcipotriene and was generally preferred to calcipotriene ointment by patients. Calcitriol was also significantly more effective for the treatment of psoriasis lesions affecting flexural areas. In another study, patients who received calcitriol ointment exhibited improvement in psoriasis symptoms that was similar to the corticosteroid betamethasone propionate, but were much less likely to have relapsed eight weeks after treatment discontinuation. Two clinical studies also suggested that calcitriol is similar in efficacy to short-contact dithranol, but with a lower incidence of skin irritation and staining. Together, the results of these studies demonstrate that calcitriol 3 microg/g ointment is a significant new option for topical therapy of psoriasis. Calcitriol ointment produces improvement in psoriasis symptoms that is generally similar to the improvement attained with other (except for high potency steroid) topical psoriasis therapies, with a low incidence of adverse events.