calcipotriene and Keratosis

Topical calcipotriene ointment has been approved for the treatment of plaque-type psoriasis.. This article explores the possible use of topical calcipotriene ointment in the treatment of nail and intertriginous psoriasis, palmoplantar and pustular psoriasis, Reiter's syndrome, pityriasis rubra pilaris, and disorders of keratinization.. The recent literature is reviewed.. Recent reports suggest that certain ichthyoses (particularly the hyperproliferative variants) and keratodermas may respond to topical calcipotriene ointment. The activity of calcipotriene relates to a dose-dependent decrease in proliferation and an increase in terminal differentiation of keratinocytes.. Patients with other disorders characterized by epidermal hyperproliferation may also be candidates for treatment. The use of calcipotriene in treating congenital hyperproliferative disorders is limited by the theoretical risk of hypercalcemia from absorption of the drug after application to extensive areas of skin.

Topics: Administration, Topical; Arthritis, Reactive; Calcitriol; Cell Differentiation; Cell Division; Dermatologic Agents; Dose-Response Relationship, Drug; Foot Dermatoses; Hand Dermatoses; Humans; Hypercalcemia; Ichthyosis; Keratinocytes; Keratosis; Nail Diseases; Ointments; Pityriasis Rubra Pilaris; Psoriasis; Skin Absorption; Skin Diseases

Topics: Adult; Aged; Calcitriol; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Humans; Keratosis; Kidney Transplantation; Middle Aged; Sunlight; Treatment Failure; Tretinoin

Disorders of keratinization are a heterogeneous group of diseases that have in common a defect in cornification. The bioactive form of vitamin D3 has been shown to modulate epidermal proliferation and differentiation. The purpose of the present study was to determine the effect of the synthetic vitamin D3 calcipotriol in a randomized, double-blind, placebo-controlled, right/left comparative study. The 67 patients included in the study were at least 12 years of age and had the following diseases: ichthyosis vulgaris (n = 9), X-linked ichthyosis (n = 8), congenital ichthyosis (n = 10), hereditary palmoplantar keratoderma (n = 20), keratosis pilaris (n = 9), and Darier's disease (n = 11). Calcipotriol ointment (50 micrograms/g) and placebo (vehicle of calcipotriol ointment) were applied to all patients twice daily for up to 12 weeks. The patients were allowed to use up to 120 g of calcipotriol ointment per week.. At the end of the treatment regimen, calcipotriol ointment had an effect on the improvement of the ichthyoses, although to a variable degree. No therapeutic effect was detected in palmoplantar keratoderma or keratosis pilaris. Eight of 12 patients with Darier's disease had to be withdrawn because of skin irritation or a worsening of the disease. Skin irritation occurred in 18 cases (26%) only on the calcipotriol-treated side, and in one case (1%) only on the placebo-treated side. Nine cases (13%) had irritation on both sides. The amount of calcipotriol ointment used per week was lowest in palmoplantar keratoderma (mean, 11.8 g/wk; range, 2.1 to 25.6 g/wk) and highest in congenital ichthyosis (mean, 59.3 g/wk; range, 11.4 to 94.7 g/wk). There was no clinically significant change of serum calcium levels during the treatment period.. Short-term treatment with calcipotriol ointment (50 micrograms/g) used in amounts up to about 100 g/wk is moderately efficacious, well-tolerated, and safe in adult patients with various ichthyoses.

Topics: Adolescent; Adult; Aged; Calcitriol; Child; Darier Disease; Dermatologic Agents; Double-Blind Method; Drug Eruptions; Female; Humans; Ichthyosis; Ichthyosis Vulgaris; Ichthyosis, X-Linked; Keratoderma, Palmoplantar; Keratosis; Male; Middle Aged; Ointments; Pharmaceutical Vehicles; Placebos

Topics: Adult; Breast Diseases; Breast Neoplasms; Calcitriol; Dermatologic Agents; Diagnosis, Differential; Eczema; Female; Humans; Hyperpigmentation; Keratosis; Nipples; Paget's Disease, Mammary

Topics: Acitretin; Administration, Cutaneous; Administration, Oral; Adult; Calcitriol; Chronic Disease; Dermatologic Agents; Drug Therapy, Combination; Glucocorticoids; Humans; Keratolytic Agents; Keratosis; Lichenoid Eruptions; Lower Extremity; Male; Rare Diseases; Time Factors; Torso; Treatment Failure; Ultraviolet Therapy; Upper Extremity

Topics: Administration, Topical; Biopsy; Breast Neoplasms; Calcitriol; Drug Administration Schedule; Female; Humans; Keratosis; Nevus, Pigmented; Nipples; Precancerous Conditions; Skin Neoplasms; Young Adult

Topics: Adolescent; Adrenal Cortex Hormones; Calcitriol; Child; Chronic Disease; Conjunctivitis; Consanguinity; Humans; Keratosis; Lichenoid Eruptions; Male; Skin Pigmentation

Keratosis lichenoides chronica (KLC) is a rare disease, with approximately 70 cases reported in the literature. The problem in this long-lasting disease is generally the treatment, not the diagnosis. In the literature, many treatments failed to show any beneficial effect. We present a 20-year-old man with KLC that was successfully treated with a combination of phototherapy, acitretin and calcipotriol ointment. The patient's lesions showed a marked improvement with this combination. To our knowledge, this is the first report of this type of combination treatment being used successfully in KLC. This approach might help reduce doses of retinoids or psoralen ultraviolet A required when these are used separately, and limit the potential toxicity of these treatments.

Topics: Acitretin; Administration, Cutaneous; Calcitriol; Chronic Disease; Combined Modality Therapy; Dermatologic Agents; Humans; Keratosis; Lichenoid Eruptions; Male; Phototherapy; Treatment Outcome; Young Adult

Hyperkeratosis of the nipple and areola is a rare disorder characterized by verrucous thickening and brown pigmentation of the nipple and areola with unknown etiology. Although it is a generally asymptomatic disorder, cosmetic disfiguring creates a real psychological problem for young women. Moreover, treatment regimens are not satisfactory. Surgical treatment has been suggested as an initial treatment in resistant and recurrent cases because of the relapses seen after medical treatment. We report a case who responded satisfactorily to low-dose acitretin and topical calcipotriol treatment with no relapses during 2 years of follow-up. Among all reported medical treatments and interventional approaches, including surgery, this is the first patient reported with 2 years of remission.

Topics: Acanthosis Nigricans; Acitretin; Administration, Cutaneous; Adolescent; Breast Diseases; Calcitriol; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Keratolytic Agents; Keratosis; Nipples; Treatment Outcome

Topics: Acanthosis Nigricans; Administration, Topical; Adult; Calcitriol; Dermatologic Agents; Female; Humans; Keratosis; Nipples

Topics: Acitretin; Calcitriol; Controlled Clinical Trials as Topic; Dermatologic Agents; Eccrine Glands; Gels; Hamartoma; Humans; Ichthyosis Vulgaris; Ichthyosis, X-Linked; Keratoderma, Palmoplantar; Keratolytic Agents; Keratosis; Nicotinic Acids; Ointments; Porokeratosis; Retinoids; Sweat Gland Diseases; Time Factors; Treatment Outcome

Hyperkeratosis lenticularis perstans (HLP) or Flegel's disease is a rare dermatosis characterized by asymptomatic hyperkeratotic papules predominantly located on the lower extremities. Lesional and non-lesional epidermis samples were studied by light- and electron-microscopic examination. The main ultrastructural finding was the presence of structurally altered Odland bodies/membrane-coating granules. Different therapeutic options for HLP have been reported, but none of the treatments was shown to be consistently effective. Here, we report on a patient with Flegel's disease who did respond to topical 5-fluorouracil, whereas topical vitamin D(3) synthetics were ineffective.

Topics: Calcitriol; Dermatologic Agents; Dihydroxycholecalciferols; Female; Humans; Keratosis; Leg Dermatoses; Microscopy, Electron; Middle Aged; Skin; Treatment Outcome

Keratosis lichenoides chronica (KCL) is a rare dermatosis characterized by a distinctive seborrheic dermatitis-like facial eruption, together with violaceous, papular, and nodular lesions on the extremities and trunk, typically arranged in a linear and reticulate pattern. KLC is resistant to therapy, although spontaneous remission has been reported. We describe a 35-year-old woman with KLC who had the typical features of widespread violaceous, reticulate, and striae-like eruptions with a prominent keratotic component over a nine-year period and who responded well to treatment with calcipotriol ointment. The immunohistochemical profiles are presented in addition to typical histopathologic features.

Topics: Administration, Cutaneous; Adult; Calcitriol; Chronic Disease; Dermatitis, Seborrheic; Dermatologic Agents; Facial Dermatoses; Female; Humans; Keratosis; Lichenoid Eruptions; Ointments; Pigmentation Disorders; Remission, Spontaneous

Topics: Administration, Cutaneous; Calcitriol; Chronic Disease; Dermatologic Agents; Female; Humans; Keratosis; Middle Aged; Ointments

A flow-cytometric study was performed in monogenic disorders of keratinization, to assess DNA distribution as well as the expression of keratins and involucrin. In addition, the changes in expression of these markers under influence of calcipotriol treatment were investigated. Proliferation, measured by the percentage of epidermal cells in SG2M-phase of the cell cycle, was increased in Darier's disease, lamellar ichthyosis, congenital bullous ichthyotic erythroderma of Brocq and the Comel-Netherton syndrome, whereas normal proliferation was found in autosomal dominant ichthyosis vulgaris, X-linked recessive ichthyosis, keratosis pilaris, ichthyosis bullosa of Siemens and the Sjögren-Larsson syndrome. Keratin 6 was enhanced in erythrodermic lamellar ichthyosis, congenital bullous ichthyotic erythroderma of Brocq and the Comel-Netherton syndrome, showing also reduction of keratin 10. Involucrin was only slightly reduced in erythrodermic lamellar ichthyosis, congenital bullous ichthyotic erythroderma of Brocq and the Comel-Netherton syndrome, compared to the pronounced reduction in all other skin disorders studied. Calcipotriol was found to enhance differentiation in Darier's disease, erythrodermic lamellar ichthyosis, and congenital bullous ichthyotic erythroderma of Brocq. Only Darier's disease did not show clinical improvement. In conclusion, flow cytometry provides a useful method for quantification of epidermal cell characteristics in monogenic disorders of keratinization. Further studies need to be performed to establish its usefulness as a diagnostic and prognostic tool.

Topics: Administration, Topical; Calcitriol; Cell Division; Cells, Cultured; Dermatologic Agents; DNA; Epidermal Cells; Flow Cytometry; Humans; Ichthyosis; Keratosis; Reference Values; Sensitivity and Specificity

A 26-week repeated percutaneous dose toxicity of calcipotriol (MC903), an anti-psoriasic agent, was studied in beagle dogs at doses of 0.04, 0.4 and 4 micrograms/kg/day. 1. In general conditions, reddening, rash, desquamation, pruritus, wet and hot skin at 4 micrograms/kg/day, reddening, rash and desquamation at 0.4 microgram/kg/day, pruritus and desquamation at 0.04 microgram/kg/day, were observed at the skin of application site. 2. In urinalysis, an increase or a tendency to an increase in Ca level, were observed at 4 micrograms/kg/day. 3. Histopathological examinations revealed squamous cell hyperplasia and parakeratosis at the skin of application site in both sexes at 4 micrograms/kg/day. However, these findings were not shown at the skin of application site at 0.4 and 0.04 microgram/kg/day. 4. On the basis of results obtained in the present study, it is considered that 0.4 microgram/kg/day is the no-toxic dose of MC903 applied percutaneously in both sexes of beagle dogs.

Topics: Administration, Cutaneous; Animals; Calcitriol; Calcium; Dermatologic Agents; Dogs; Drug Administration Schedule; Female; Hyperplasia; Keratosis; Male; Pruritus; Skin

A 26-week repeated percutaneous dose toxicity of calcipotriol (MC903), an anti-psoriasic agent, was studied in Slc:SD rats at doses of 0.8, 4 and 20 micrograms/kg/day as low, mid and high dose levels. 1. No mortality were observed in both sexes of all groups including control. An increased water consumption was observed in females at mid dose and in both sexes at high dose. 2. An increased incidence of the corneal opacity in males at mid dose and in both sexes at high dose was noted significantly as compared with that observed in control. Urinalysis revealed a slight increased urinary volume, increased excretions of Ca and IP, and lower pH in both sexes at more than mid dose. Levels of the serum IP in females and Ca in both sexes were elevated at high dose. 3. The increased weights of the kidney in males and adrenal gland in females were observed at high dose. The kidney in females at mid dose and in both sexes at high dose showed a higher incidence of mineralization than in control. Furthermore, osteosclerosis of the sternum and femur in both sexes, and hyperkeratosis of the skin at application site in females at high dose were observed. Electron microscopic examination revealed no abnormality in the liver and kidney. 4. On the basis of results obtained in the present study, it is considered that 0.8 microgram/kg/day is the no-toxic dose of MC903 applied percutaneously in both sexes of rats.

Topics: Administration, Cutaneous; Animals; Calcitriol; Calcium; Corneal Opacity; Dermatologic Agents; Drug Administration Schedule; Female; Keratosis; Kidney; Male; Minerals; Organ Size; Phosphates; Rats; Rats, Sprague-Dawley