From the Guidelines
Skin atrophy is the expected side effect with topical corticosteroids but not with calcipotriene (vitamin D) in patients with psoriasis requiring prolonged topical treatment. Topical corticosteroids work by reducing inflammation and suppressing the immune response, but with extended use, they can cause thinning of the skin (atrophy), striae (stretch marks), telangiectasia (visible blood vessels), and increased susceptibility to infections. This occurs because corticosteroids inhibit collagen synthesis and reduce epidermal cell proliferation over time, as noted in the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1.
Key Points to Consider
- The most common local skin adverse effects of topical corticosteroid use include skin atrophy, striae, folliculitis, telangiectasia, and purpura, with face and intertriginous areas being at greatest risk 1.
- Calcipotriene, a vitamin D analog, works by normalizing keratinocyte differentiation and proliferation without causing skin atrophy, making it more suitable for long-term maintenance therapy 1.
- Combination therapy is often used in psoriasis treatment—corticosteroids for quick relief of inflammation followed by calcipotriene for maintenance—to minimize the risk of steroid-related side effects while maintaining disease control.
- For areas particularly susceptible to atrophy, such as the face and intertriginous areas, calcipotriene may be preferred for long-term use, as it does not cause the same level of skin atrophy as topical corticosteroids 1.
Evidence-Based Recommendation
Based on the most recent and highest quality study available, the use of calcipotriene is recommended for long-term maintenance therapy in patients with psoriasis to avoid the risk of skin atrophy associated with prolonged topical corticosteroid use 1. This approach aligns with the guidelines of care for the management and treatment of psoriasis, emphasizing the importance of balancing efficacy with the risk of side effects in the treatment of psoriasis.
From the FDA Drug Label
ADVERSE REACTIONS Clinical Trials Experience In controlled clinical trials, the most frequent adverse experiences reported for calcipotriene were burning, itching and skin irritation, which occurred in approximately 10 to 15% of patients. Erythema, dry skin, peeling, rash, dermatitis, worsening of psoriasis including development of facial/scalp psoriasis were reported in 1 to 10% of patients Other experiences reported in less than 1% of patients included skin atrophy, hyperpigmentation, hypercalcemia, and folliculitis. The expected side effect with use of topical corticosteroids but not with calcipotriene is skin atrophy. This is because skin atrophy is a known side effect of prolonged topical corticosteroid use, but it is reported in less than 1% of patients using calcipotriene 2.
- Skin atrophy is the correct answer, as it is a side effect associated with topical corticosteroids, but not commonly with calcipotriene.
- The other options, rash, peeling skin, and dry skin, are all possible side effects of calcipotriene, and therefore not the correct answer.
From the Research
Side Effects of Topical Corticosteroids and Calcipotriene
The question asks about the side effect expected with topical corticosteroids but not with calcipotriene in a patient with psoriasis requiring prolonged topical treatment. The correct answer can be determined by analyzing the provided evidence.
Comparison of Side Effects
- Topical corticosteroids are known to cause skin atrophy, especially with prolonged use 3, 4, 5, 6.
- Calcipotriene, on the other hand, is not associated with skin atrophy and may even thicken the skin 3, 7.
- Other side effects such as rash, peeling skin, and dry skin may occur with both topical corticosteroids and calcipotriene, but skin atrophy is a specific side effect more commonly associated with topical corticosteroids.
Expected Side Effect
Based on the evidence, the side effect expected with topical corticosteroids but not with calcipotriene is:
The correct answer is: b. skin atrophy