Can corticosteroids be used in combination with calcipotriene for the treatment of psoriasis?

From the Guidelines

Yes, corticosteroids can be effectively used in combination with calcipotriene for the treatment of psoriasis, as evidenced by a 52-week study with 828 patients, where 69% to 74% of patients achieved clear or almost clear status compared to 27% of patients treated with vehicle control (P < .001) 1. This combination therapy is a common and recommended approach for managing plaque psoriasis. The combination is available as pre-formulated products such as Taclonex (calcipotriene 0.005% and betamethasone dipropionate 0.064%) or Enstilar foam, which can be applied once daily to affected areas for up to 4 weeks for body psoriasis and up to 8 weeks for scalp psoriasis. Some key points to consider when using this combination therapy include:

• The combination works well because these medications have complementary mechanisms of action: calcipotriene (a vitamin D analog) normalizes skin cell growth and differentiation, while corticosteroids reduce inflammation and itching.
• This dual approach often provides better efficacy than either agent alone while potentially reducing the side effects associated with long-term corticosteroid use, such as skin thinning.
• The combination therapy is particularly useful for moderate to severe plaque psoriasis and can lead to faster clearance of psoriatic lesions compared to monotherapy with either agent.
• According to the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy, the use of combination treatments with vitamin D analogues and potent topical corticosteroids from 3 to 52 weeks is more effective than either agent alone for the treatment of psoriasis 1.
• Additionally, 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.

From the Research

Combination Therapy for Psoriasis

• Corticosteroids can be used in combination with calcipotriene for the treatment of psoriasis, as evidenced by studies showing improved benefit/risk ratios and reduced side effects 2.
• The combination of calcipotriene and corticosteroids, such as betamethasone dipropionate, has been shown to be more effective than monotherapy in reducing inflammation and improving skin differentiation 3.

Efficacy and Safety of Combination Therapy

• Calcipotriene 0.005% foam has been found to be a safe and effective topical treatment for plaque psoriasis, although it is often used as a second-line agent due to its slow onset of action 4.
• The combination of calcipotriene and betamethasone dipropionate has been shown to be well-tolerated and effective in reducing hyperproliferation of keratinocytes and normalizing keratinocyte differentiation 5.
• Long-term use of calcipotriene/betamethasone dipropionate has been found to be effective and safe, with minimal risk of corticosteroid-related adverse events 5.

Clinical Applications of Combination Therapy

• Calcipotriene ointment has been found to be effective in combination with other antipsoriatic agents, such as acitretin, cyclosporine, and ultraviolet B or psoralen ultraviolet A (PUVA) phototherapy, in improving overall disease severity in adult patients with moderate to severe psoriasis 6.
• The combination of calcipotriene and betamethasone dipropionate has been found to be effective in reducing the dosage and duration of other antipsoriatic treatments, potentially improving their benefit/risk ratio 6.