About the Author
Vimal H. Prajapati, MD, FRCPC, DABD
Dr. Prajapati is a Clinical Associate Professor at the University of Calgary, co-creator of The Dermatology Philosophy, as well as co-founder and co-director of the Skin Health & Wellness Centre, Dermphi Centre, Dermatology Learning Institute, Dermatology Research Institute, Dermphi Therapeutics, and D&P Commercial Group. Additionally, he has started several subspecialty initiatives, including multidisciplinary clinics for pediatric morphea, pediatric scleroderma, and pediatric psoriasis in Calgary, rapid access clinics for psoriasis and eczema in Calgary, as well as rural outreach clinics for psoriasis and eczema in Medicine Hat.
Special Supplement, Canadian Dermatology Today, February, 2022
An Update On The Fixed-Dose Combination Topical Corticosteroid/Vitamin D3 Analogue (Betamethasone Dipropionate-Calcipotriol) For Plaque Psoriasisdiluted And Hyperdiluted Calcium Hydroxyapatite For Skin Tightening
Plaque psoriasis is a chronic, recurrent, immune-mediated, inflammatory skin disease that can have a significant negative impact on patient and family quality of life. The therapeutic landscape for this condition has evolved considerably over the past two decades, with many novel treatments receiving approval in Canada and other countries around the world. Despite these advances, which include targeted systemic therapies that are allowing patients to achieve higher levels of skin clearance, topical therapies remain a mainstay in the management of plaque psoriasis.
Most, if not all, patients with plaque psoriasis will be prescribed topical therapies at some point in their treatment course. They are commonly used as first-line monotherapy to treat mild-to-moderate disease as well as moderate-to-severe disease (before initiating light and/or systemic therapy) and as adjunctive therapy to treat moderate-to-severe disease (when complete skin clearance is not achieved by light and/or systemic therapy). Although many options are available, it has been shown that patients with plaque psoriasis have different preferences for topical therapy, which ultimately impacts adherence, thereby highlighting the importance of shared decision-making and individualized treatment approaches. Factors that must be taken into consideration include efficacy, convenience, cosmetic acceptability, safety/ tolerability, and access/cost of a product.
Currently approved topical therapies for plaque psoriasis include products with a single active ingredient (corticosteroid, retinoid, or vitamin D3 analogue) and products with two active ingredients in a fixed-dose combination (corticosteroid/keratolytic, corticosteroid/retinoid, or corticosteroid/vitamin D3 analogue). For close to two decades now, fixed-dose combination products featuring a corticosteroid (betamethasone dipropionate) and vitamin D3 analogue (calcipotriol) in various formulations— initially ointment, now gel and foam as well—have been widely utilized by patients with plaque psoriasis across the entire disease severity spectrum and developed a strong legacy in dermatology.
The focus of this supplement is to provide an update on the most recent clinical trial and real-world data for the fixed-dose combination topical corticosteroid/ vitamin D3 analogue (betamethasone dipropionate-calcipotriol). Herein, the authors will specifically review: (1) mechanism of action; (2) efficacy in terms of physician-reported outcomes (e.g., improvements in Psoriasis Area and Severity Index [PASI] and Physician Global Assessment [PGA] scores); (3) efficacy in terms of patient-reported outcomes (e.g., improvements in itch and pain Visual Analog Scale (VAS) scores as well as health-related quality of life [HRQoL] measures, such as Children’s Dermatology Life Quality Index [CDLQI]/Dermatology Life Quality Index [DLQI]); and (4) safety