Can topical calcipotriol be used concurrently with narrow band Ultraviolet B (UVB) treatment?

From the Guidelines

Topical calcipotriol can be used concurrently with narrow band Ultraviolet B (UVB) treatment for conditions like psoriasis, with the recommendation to apply calcipotriol after phototherapy or at least 2 hours before treatment to avoid potential interactions. This combination therapy often provides enhanced efficacy compared to either treatment alone, as noted in the guidelines of care for the management and treatment of psoriasis with topical therapies 1. The reason for timing separation is that calcipotriol can be degraded by UV light, reducing its effectiveness, and there were historical concerns about increased photosensitivity, though recent evidence suggests this risk is minimal 1.

Key Considerations

• Apply calcipotriol once or twice daily as prescribed, but not immediately before UVB sessions.
• The use of combination treatments with vitamin D analogues and potent topical corticosteroids is more effective than either agent alone for the treatment of psoriasis 1.
• Ultraviolet A (UVA) radiation can decrease the concentration of calcipotriene on the skin, and thick layers of calcipotriene can block ultraviolet B (UVB), thereby increasing the minimal erythema dose 1.
• Vitamin D analogues can be used in conjunction with phototherapy but should be applied after the phototherapy treatment to avoid inactivation by UVA and blocking UVB radiation 1.

Evidence-Based Recommendations

• A systematic review of RCTs concluded that when given for 3 to 8 weeks, ultrapotent or potent corticosteroid treatments outperform calcipotriene, but calcipotriene combined with potent betamethasone dipropionate was slightly more efficacious than betamethasone as a monotherapy 1.
• In a 52-week study with 828 patients, 69% to 74% of patients in the group treated with calcipotriene 0.005% plus betamethasone 0.064% once or twice daily achieved clear or almost clear status compared with 27% of the patients treated with vehicle control (P < .001) 1.
• For optimal results, follow your dermatologist's specific instructions regarding application timing and frequency, as they may customize the regimen based on your skin condition severity and response to treatment.

From the FDA Drug Label

Patients that apply Calcipotriene Topical Solution, 0. 005% (Scalp Solution) to exposed portions of the body should avoid excessive exposure to either natural or artificial sunlight (including tanning booths, sun lamps, etc.). Physicians may wish to limit or avoid use of phototherapy in patients that use Calcipotriene Topical Solution, 0. 005% (Scalp Solution).

Topical calcipotriol should not be used concurrently with narrow band UVB treatment, as the drug label suggests that physicians may wish to limit or avoid use of phototherapy in patients using calcipotriol due to the potential for enhanced effects of UVR to induce skin tumors 2.

From the Research

Topical Calcipotriol and Narrow Band UVB Treatment

• The use of topical calcipotriol in combination with narrow band UVB treatment has been studied in several clinical trials 3, 4, 5, 6, 7.
• These studies have shown that the combination of topical calcipotriol and narrow band UVB treatment can be effective in treating psoriasis, with some studies demonstrating a UVB-sparing effect 4, 5.
• The efficacy of the combination treatment has been compared to treatment with narrow band UVB alone or with other topical agents, such as dithranol or maxacalcitol 5, 6.
• While some studies have found that the addition of calcipotriol to narrow band UVB treatment does not provide additional benefit 7, others have reported improved outcomes with the combination treatment 3, 4, 5.

Safety and Tolerability

• The safety and tolerability of topical calcipotriol in combination with narrow band UVB treatment have been evaluated in several studies 3, 4, 5, 6.
• These studies have reported that the combination treatment is generally well-tolerated, with a similar adverse event profile to treatment with narrow band UVB alone or with other topical agents 3, 4, 5, 6.
• However, one study found that the addition of calcipotriol to narrow band UVB treatment did not alter the tolerability or safety of topically applied calcipotriol 3.

Clinical Implications

• The use of topical calcipotriol in combination with narrow band UVB treatment may be a useful therapeutic option for patients with psoriasis 3, 4, 5, 6.
• However, the decision to use this combination treatment should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 3, 4, 5, 6.
• Further studies are needed to fully evaluate the efficacy and safety of this combination treatment and to determine its place in the treatment of psoriasis 3, 4, 5, 6, 7.