•Topical: Unknown; however, calcipotriene inhibits keratinocyte proliferation (without anyevidence of cytotoxic effect) and induces terminal differentiation of keratinocytes, thus reversing the abnormal keratinocyte change in psoriasis. Calcipotriene exhibits a vitamin D-like effect by competing for the cellular receptors for calcitriol (1,25[OH] 2D 3), a biologically active metabolite of vitamin D. These calcitriol receptors have been identified on keratinocytes of both normal and psoriatic skin . In vitro data suggest that calcipotriene is equal to calcitriol in its ability to inhibit proliferation and induce differentiation of many cell types . Animal data show calcipotriene to be
100 to 200 times less potent in its effects on calcium metabolism as compared with those of calcitriol .
•In open studies involving 400 patients treated with topical calcipotriene for up to 1 year, half ofthe studies excluded patients who had responded poorly to previous use of calcipotriene .
Calcipotriene used for 8 weeks resulted in:
•Ointment-With use of calcipotriene once a day, 57% of patients studied showed markedimprovement and 6% complete clearing of psoriasis . In another study of patients using ointment twice a day, 70% of patients showed marked improvement and 11% complete clearing of psoriasis . Since these patients were not compared in the same study, the difference, among other factors, may be due to the population studied, the vehicle, and the time of the year when treated. Using calcipotriene twice a day is not considered to be superior in efficacy to its use once a day . • Cream (used twice a day)-50% of patients showed marked improvement and 4% showed complete clearing in patients studied.
•Solution (used twice a day)-17% of patients showed marked improvement and 14% showedcomplete clearing in 31% of patients studied .
•Calcipotriene seems to have an immunoregulatory role that involves the skin immune system,and is associated with variable decreases in keratinocyte expression of markers of activation . Calcipotriene may reduce the release of cytokines from different cell lineages; it may also govern a down-regulation of cell adhesion molecules (CAMs) that are known to mediate the passage of activated T-lymphocytes in the dermis and in the epidermis, thereby producing a reduction of cellular infiltrates in psoriasis .
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