Is calcipotriene (vitamin D analog) cream effective for treating Grover's disease?

Calcipotriene Cream for Grover's Disease

Calcipotriene cream can be an effective treatment option for Grover's disease, particularly for cases that are persistent and pruritic. While there are limited high-quality studies specifically examining calcipotriene for Grover's disease, case reports show promising results with significant clinical improvement.

Mechanism and Rationale

Calcipotriene (also known as calcipotriol) is a vitamin D analog that:

• Inhibits keratinocyte proliferation
• Enhances keratinocyte differentiation 1
• May help normalize the acantholytic changes seen in Grover's disease

Evidence for Use in Grover's Disease

The evidence specifically for Grover's disease comes primarily from case reports:

• An 84-year-old man with Darier-like pattern of Grover's disease showed significant clinical improvement after just three weeks of calcipotriene ointment monotherapy 2
• A 74-year-old man with highly pruritic Grover's disease experienced complete remission within three weeks using a combination of calcipotriene ointment and low-dose acitretin 3

Treatment Approach

For Grover's disease with calcipotriene:

1. Apply calcipotriene cream 0.005% twice daily to affected areas
2. Continue for at least 3-4 weeks to evaluate response
3. Monitor for local irritation, which is the most common side effect

Advantages of Calcipotriene for Grover's Disease

• Steroid-sparing effect - Reduces need for prolonged topical corticosteroid use 1
• Targets acantholysis - Addresses the fundamental histological abnormality in Grover's disease 4
• Relatively safe for long-term use - Unlike potent topical corticosteroids, calcipotriene can be used for extended periods 1
• Particularly effective for pruritus - Case reports suggest good control of itching, which is often the most bothersome symptom 3, 5

Important Considerations and Limitations

• Irritation potential: Calcipotriene may cause irritation, particularly on sensitive skin areas
• Maximum weekly dose: Should not exceed 100g per week to avoid risk of hypercalcemia 1
• Combination therapy: For more severe or resistant cases, consider combining with:
  • Low-potency topical corticosteroids for sensitive areas
  • Medium to high-potency topical corticosteroids for thicker lesions
  • Oral retinoids for widespread disease 6, 3

Practical Application Tips

• Apply calcipotriene to dry skin
• Avoid application immediately before or after phototherapy as UVA radiation can decrease its concentration on the skin 1
• If using in combination with topical corticosteroids, they can be applied at different times of day or as part of a rotational regimen 1
• Consider adding emollients to reduce irritation and enhance efficacy 1

While calcipotriene is primarily FDA-approved for psoriasis, its mechanism of action targeting keratinocyte proliferation and differentiation makes it a rational choice for Grover's disease, which shares some pathophysiological features with other acantholytic disorders.