Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence.
- Linda F Stein Gold
- Seminars in cutaneous medicine and surgery
Calcitriol ointment has been approved for the treatment of psoriasis in many countries around the world. It may be prescribed in conjunction with phototherapy. Our purpose was to evaluate the effect of various therapeutic ultraviolet modalities on the stability of calcitriol and, conversely, to study the effects of calcitriol ointment on transmission of different forms of ultraviolet light. Calcitriol ointment 3 microg per g was irradiated with 10 J per cm2 ultraviolet A, 100 mJ per cm2 broadband ultraviolet B, and 3.0 J per cm2 narrowband ultraviolet B, and its stability was compared with samples exposed to fluorescent light and ambient sunlight. Ultraviolet A and ultraviolet B transmission were measured through thin and thick layers of calcitriol 3 microg per g ointment and vehicle. More than 90% of calcitriol ointment is degraded upon exposure to ultraviolet A, broadband ultraviolet B, and narrowband ultraviolet B. Transmission of ultraviolet A is reduced through calcitriol ointment and its vehicle by 17%-31% and 17%-41%, respectively. Transmission of ultraviolet B is reduced by 67%-87% through vehicle and 50%-83% through calcitriol ointment. When used in conjunction with phototherapy, calcitriol ointment should be applied after ultraviolet exposure, not before. Calcipotriene, the only vitamin D analog already approved for psoriasis in the USA, has been used successfully in combination with ultraviolet B and psoralen plus ultraviolet A.