No additional effect of topical calcipotriol on narrow-band UVB phototherapy in patients with generalized vitiligo

BACKGROUND/PURPOSE: There is no definite cure for vitiligo; however, treatment responses with photobiological modalities are quite acceptable. Of all these, narrow-band UVB phototherapy was proposed rather recently. Calcipotriol has been shown to have stimulating activity on melanogenesis besides immunomodulatory and anti-inflammatory effects. This study was performed to determine whether adding topical calcipotriol to narrow-band UVB phototherapy enhances the efficacy of treatment. METHODS: In this prospective, single-blinded (investigator), right-left comparison clinical study, 20 patients with generalized vitiligo were enrolled. Symmetrical lesions with similar sizes, bilaterally distributed on arms, legs, hands, feet or trunk were selected as reference lesions. In addition to narrow-band UVB, totally 96 treatment sessions, received two or three times weekly, the patients were asked to apply 0.005% topical calcipotriol on the selected side of the reference lesions twice daily. Then, they were monitored at the end of every 24-session interval. RESULTS: Cosmetically acceptable repigmentation was observed in 55% (11/20) of the patients without taking calcipotriol into account. There was statistically significant better response on the side that calcipotriol was not applied at the 24th session (P < 0.05). No statistically significant difference was found between the calcipotriol-treated and non-treated sides at 48th, 72th, and 96th sessions (P > 0.05). CONCLUSION: Our data confirm that, narrow-band UVB phototherapy is effective by itself in vitiligo, and show that adding topical calcipotriol does not improve treatment outcome.     

Comparison of the efficacy of calcipotriol and maxacalcitol in combination with narrow-band ultraviolet B therapy for the treatment of psoriasis vulgaris

BACKGROUND: Combination treatment with topical vitamin D(3) and narrow-band ultraviolet B (UVB) radiation is effective against psoriasis vulgaris. We compared the efficacy of the topical vitamin D(3) derivatives calcipotriol and maxacalcitol in combination therapy. MATERIALS AND METHODS: In this retrospective observational study, 21 patients admitted to Nagoya City University Hospital between April 2001 and September 2004 were enrolled. RESULTS: Combination treatment with calcipotriol or maxacalcitol and narrow-band UVB was effective against psoriasis vulgaris. Calcipotriol induced a more rapid improvement and required lower levels of narrow-band UVB irradiation to be effective. Serum calcium levels were slightly increased after 4 weeks of treatment, but there was no significant difference between the two groups. No other adverse effects were observed in either of the two groups. CONCLUSION: The findings of this retrospective observational study indicated that combination treatment with topical vitamin D(3) derivatives and narrow-band UVB is effective against psoriasis without any obvious side-effects. These findings provide further evidence that calcipotriol has advantages over maxacalcitol regarding the narrow-band UVB-accumulated treatment dose and improvement rate of psoriasis area and severity index (PASI) scores.     

Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo

BACKGROUND: Narrow band ultraviolet B (NB-UVB) phototherapy has been used successfully for the treatment of vitiligo. Recently, topical calcipotriol has also been claimed to be effective, either as monotherapy or as a part of combination therapies. OBJECTIVE: The aim of the present study was to compare the clinical efficacy of NB-UVB and NB-UVB plus topical calcipotriol in the treatment of vitiligo. METHODS: NB-UVB treatment was given to 24 patients with generalized vitiligo three times weekly. Topical calcipotriol cream was only applied to the lesions located on the right side of the body. Treatment was continued for 6 months. Treatment efficacy was evaluated by determining the average response rates of the lesions at 3-month intervals. RESULTS: The average response rates of patients receiving combination of NB-UVB plus calcipotriol and NB-UVB alone were 51 +/- 19.6% and 39 +/- 18.9%, respectively. The median cumulative UVB dose and number of UVB exposures for initial repigmentation were 6345 mj/cm(2) (range; 2930-30980) and 18 (range; 12-67) for the combination therapy, and 8867.5 mj/cm(2) (range; 2500-30980) and 24 (range; 15-67) for the narrow band UVB therapy, respectively. CONCLUSIONS: These findings indicate that concurrent topical calcipotriol potentates the efficacy of NB-UVB in the treatment of vitiligo. This combination not only provides earlier pigmentation with lower total UVB dosage and less adverse UVB effects, but also reduces the duration and cost of treatment as well.     

UVA与UVB治疗寻常型银屑病临床对照研究

目的：评价煤焦油软膏外用联合UVA＋UVB照射治疗寻常型银屑病的疗效及安全性。方法：91例寻常型银屑病患者外用煤焦油软膏联合UVA＋UVB照射，并与53例寻常型银屑病患者外用煤焦油软膏联合UVA、51例联合UVB照射进行对比观察。结果：治疗8周后UVA＋UVB组痊愈率为63．74％，总有效率为98．90％，明显高于UVA组和UVB组；治疗2周、4周、6周和8周后PASI评分均较治疗前明显下降，UVA＋UVB组与UVA组、UVB组对比有显著性差异；1年内复发率UVA＋UVB组27．66％，明显低于UVA组或UVB组。结论：外用煤焦油软膏联合UVA＋UVB照射治疗寻常型银屑病较单纯联合UVA或UVB照射疗效高、复发率低。     

Effects of calcipotriol cream and ointment, clobetasol cream and ointment and tretinoin cream on the erythemogenicity of UVB

Various studies have shown the blocking effects of topical agents on UVB penetration, which can be used in combination with phototherapy. In this study, the photoprotective effects of 0.005% calcipotriol, 0.05% clobetasol-17-propionate, and 0.1% tretinoin, which can be used in combination with broad-band UVB, were investigated in an in vivo test. In a study group of 20 patients, phototests were performed to determine minimal erythema doses (MED) and the tests were repeated with thin (0.1 cc/25 cm2) and thick (0.3 cc/25 cm2) calcipotriol, clobetasol-17-propionate, and tretinoin in cream forms and sunscreen. After determining the MED, the test was repeated in another 20 patients with thin and thick calcipotriol and clobetasol-17-propionate in both cream and ointment forms and sunscreen. MED was increased with thin and thick applications of all agents. Moreover, the photoprotective effects of each agent increased with their thick applications compared with thin ones. The application of calcipotriol cream and ointment, clobetasol cream and ointment, and tretinoin cream, all of which can block UVB, is not recommended just before phototherapy.     

Effect of antioxidants and free radical scavengers on protection of human skin against UVB, UVA and IR irradiation

Background/aims: This study was designed to observe the effect of a mix of commercial antioxidants and free radical scavengers (AO) on protection of human skin against different wavelengths of the solar spectrum: 280-320 nm (UVB), 320-400 nm (UVA) and 400-900 nm (IR).
Methods: Healthy volunteers were chosen from the local population and exposed to the three aspects of the solar spectrum. Erythema at 24 h, immediate pigment darkening (IPD) and immediate erythema were employed as markers for UVB, UVA and IR exposure, respectively.
Results: Based on 24 h erythema measurements, the AO mix afforded about 2.6-fold (163%) protection against UVB-induced erythema (Table 1). IPD measurements after UVA exposure exhibited 76% protection afforded by the AO mix. The AO mix reduced IR-induced increases in erythema and blood flow by 43% and 52%, respectively (Table 1).
Conclusions: Data from these studies suggest that treatment with antioxidants prior to exposure to solar irradiation allows protection of human skin against IR as well as UVB and UVA. Antioxidants and free radical scavengers may be valuable adjuncts to traditional sunscreens, for protection of skin against the effects of actinic exposure that, over a long term, can result in formidable consequences such as skin cancer and photo-aging.     

Positive effect of using calcipotriol ointment with narrow-band ultraviolet B phototherapy in psoriatic patients

BACKGROUND/PURPOSE: The successful use of narrow-band ultraviolet B (UVB) phototherapy for the management of psoriasis has prompted the examination of various combination treatments with narrow-band UVB. However, there have been contradictory reports on the effect of the calcipotriol-narrow-band UVB combination. This study was performed to compare the clinical efficacy of the calcipotriol-narrow-band UVB combination with narrow-band UVB alone. METHODS: Of the 28 psoriasis patients, 10 were treated with the calcipotriol-narrow-band UVB and 18 with narrow-band UVB alone. Phototherapy was done once daily three times a week and the dose was gradually increased in a stepwise fashion by 0.05 J/cm2. At the end of therapy, overall efficacy was classified according to the chosen grading system. RESULTS: On assessing the therapeutic results using the criteria selected, 90.0% patients (n = 9) in the calcipotriol-narrow-band UVB group and 61.1% patients (n = 11) in the narrow-band UVB group showed grade IV at the end of therapy. The calcipotriol-narrow-band UVB group showed more rapid improvement at the early stage. The final and total UVB dose were slightly lower in the calcipotriol-narrow-band UVB group but no significant difference was observed with respect to the total number of irradiations, duration of treatment, final UVB dose or total cumulative UVB dose required to reach grade IV in both groups (P > 0.05). The pattern of adverse effects was similar in both groups with a slightly higher frequency in the calcipotriol-narrow-band UVB group. CONCLUSION: Our results demonstrated that the total cumulative UVB dose required to reach grade IV was not significantly different in both groups, although it was slightly lower in the calcipotriol-narrow-band UVB group. However, a higher percentage of patients attained grade IV at the end of therapy in the combination group and this therapy was more effective in reducing the Psoriasis Area and Severity Index early in treatment. More studies are warranted to confirm these results.     

Sunscreens – what's important to know

The popularity of sunscreens dramatically increased since ultraviolet irradiation was implicated in the pathogenesis of skin cancer and skin ageing. The absorption properties, safety, photostability of different organic and inorganic filters are reviewed: para -aminobenzoic acid, salicylates, cinnamates, benzophenones, butylmethoxydibenzoylmethane (Parsol 1789), drometrizole trisulphonic (Mexoryl XL), terephthalydene dicamphor sulphonic acid (Mexoryl SX), methylene bisbenzotriazol tetramethylbutylphenol (Tinasorb M), anisotriazine (Tinasorb S), titanium dioxide and zinc oxide. Furthermore, this review discusses the optimal methods for measuring the protection that a sunscreen offers, the role of sunscreen use in melanoma prevention and future trends in sunscreen filters development.     

Effects of topical petrolatum and salicylic acid upon skin photoreaction to UVA

Various agents which can be used in combination can also interfere with phototherapy. In this study, the effects of topical petrolatum and 20% salicylic acid in petrolatum upon skin photoreaction to UVA were investigated, in an in vivo test. Minimal phototoxic dose (MPD) test was performed on 31 volunteers and the test was repeated with thin (0.1 cc/25 cm(2)) petrolatum, thick (0.3 cc/25 cm(2)) petrolatum, thin 20% salicylic acid in petrolatum, thick 20% salicylic acid in petrolatum and sunscreen. The effect of each agent on MPD was investigated. MPD was increased with thin and thick applications of all agents. Also, MPD was increased with 20% salicylic acid in petrolatum when compared with pure petrolatum, in the same thickness. The application of petrolatum and salicylic acid in petrolatum just before PUVA therapy is not recommended because of their blocking effects.     

Influence of UVA and UVB irradiation on hepatic and cutaneous P450 isoenzymes

The influence of UVA and UVB irradiation of the skin for 1, 2 and 4 weeks on the activities of the hepatic and cutaneous P450 isoenzymes was investigated in female Wistar rats before and after systemic administration of hexachlorobenzene (HCB), a well-known porphyrogenic agent, which additionally induces P450 1A1 and P450 1A2 isoenzymes. UVA and UVB irradiation of the skin of the controls and HCB-treated animals did not influence porphyrin metabolism. In the nonporphyric rats hepatic EROD (P450 1A1) activity was induced by UVB, but the activity of ADM (P450 2B) and EMDM (P450 3A) was either minimally or not affected. In the HCB-treated (porphyric) rats UVA and UVB irradiation resulted in a significant depression of HCB-induced EROD in the liver and in the skin. In both the nonporphyric and the porphyric rats UVA and UVB irradiation had no effect on hepatic ADM activity. In the liver of the nonporphyric animals EMDM activity remained unchanged after UVA and UVB irradiation, whereas in the HCB-treated animals the activity of this enzyme was increased. Finally, after UVA and UVB irradiation cutaneous EMDM activity was increased in the controls, whereas the HCB-induced increase of this enzyme in porphyric animals was decreased. In addition long-term (28 days) UVB irradiation decreased hepatic GSH content significantly in normal and porphyric rats. These experimental findings cannot be directly extrapolated to humans; however, they suggest that exposure of human skin to UV radiation may result in alterations in the activity of cutaneous, hepatic and other extracutaneous P450 isoenzymes. Received: 27 June 1996     

Efficacy and safety of topical calcipotriol in management of alopecia areata: A pilot study

Reports have highlighted serum vitamin D deficiency and reduced 1,25‐dihydroxyvitamin D(3) receptors(VDR) expression on hair follicles of alopecia areata(AA) patients. Very few studies have demonstrated efficacy of topical calcipotriol (vitamin D analogue) in AA. We intended to study the efficacy of calcipotriol lotion 0.005% in AA and correlate its outcome with serum vitamin D levels. We conducted a prospective study, in which 22 patients with AA were treated with calcipotriol lotion 0.005% twice daily for 3 months. Clinico‐epidemiological parameters including severity of AA and SALT score were calculated at baseline and at 12 weeks. Hair regrowth was assessed monthly at 4, 8, 12 weeks. Serum vitamin D levels were measured at baseline. After 12 weeks of treatment, hair regrowth was observed in 13 (59.1%) patients. Mean period for onset of disease stabilization and hair regrowth was 4 weeks and 4.21± 2.13 weeks, respectively. Among these 13 patients, SALT₅₀ and SALT₁₀₀ was observed in 6(46.2%) and 2(9%) patients, respectively. Response to treatment was better in patients with lower vitamin D levels (p < .009). Topical calcipotriol can be an alternative treatment in AA and it could prove to be more useful in patients who are vitamin D deficient.     

Direct effects on proliferation,antigen expression and melanin synthesis of cultured normal human melanocytes in response to UVB and UVA light

BACKGROUND/PURPOSE: Ultraviolet (UV) radiation; induces a variety of responses in the skin, including tanning and inflammation, and may also act as a carcinogen. As epidermal melanocytes are seen as the major targets of UV light, the present study was conducted to evaluate the direct effects of UVA and UVB irradiation on melanocytes in vitro. METHODS: Normal human epidermal melanocytes (NHM) were exposed on 3 consecutive days to UVA (0.072-7.2 J/cm2) and UVB (7.2-48 mJ/cm2), respectively, and changes of morphology, cell number, melanin synthesis and antigen expression (APAAP technique) were determined 5 days after the first exposure. RESULTS: UVA radiation caused only minimal effects on NHM by slightly inducing expression of the activation marker HMB-45 and decreasing expression of the proliferation marker Ki-67. No changes of morphology, cell number or melanin synthesis were detectable with any of the applied doses. On the other hand, UVB radiation significantly induced dendrite formation and decreased the number of NHM in a dose-dependent manner (74% of the controls at 7.2 mJ/cm2, 64% at 14.4 mJ/cm2 and 28% at 36 mJ/cm2). Significant induction of the activation marker HMB-45 was found in parallel to decreased expression of the differentiation marker K.1.2.58. UVB doses >or=9.6 mJ/cm2 also resulted in significant downregulation of the proliferation marker Ki-67, confirming the data of the cell counts, and melanin content was increased in NHM (20% over the controls, P<0.01) after applying 7.2 mJ/cm2 UVB. CONCLUSION: Our results may suggest that the effect of UVB radiation in skin is due to direct activation of melanocytes, whereas skin tanning caused by UVA is mediated rather in an indirect way.     

Effectiveness and safety of topical calcipotriol in the treatment of flat seborrheic keratosis on the face

Seborrheic keratosis is the most common slow-growing, benign epithelial tumour, usually appearing on sun-exposed areas. Treatment modalities for seborrheic keratosis may be uncomfortable and/or time-consuming. We present a case series of 12 patients with solitary seborrheic keratosis localized on the face treated with 0.005% calcipotriol ointment. The treatment lasted 3–8 months and resulted in complete regression of the lesions. Remission (follow-up period) lasted from 6 to 10 years. We conclude that topical calcipotriol may be a useful treatment option for seborrheic keratosis.