Calcipotriol

Topical antipsoriatic, synthetic vitamin D3 analogue

ATC code: D05AX02 (Calcipotriol)

Brand names

Dovonex, Daivonex, Sorilux

Mechanism of action

Synthetic analogue of 1,25-dihydroxyvitamin D3. Binds the vitamin D receptor (VDR) in keratinocytes and: 1) suppresses excessive proliferation, 2) normalises differentiation, 3) reduces local T-lymphocyte activation and pro-inflammatory cytokine production. Activity on calcium metabolism is 100 times lower than calcitriol, allowing topical use without significant systemic hypercalcaemia at doses up to 100 g of cream per week. Effect develops gradually: first signs of improvement at 2 weeks, peak at 6-8 weeks.

Indications

Plaque psoriasis

Second line

Calcipotriol as monotherapy or, more often, in a fixed combination with betamethasone (Daivobet, Enstilar) is a treatment option for mild and moderate plaque psoriasis of trunk and limbs (PASI up to 10, BSA up to 10%). CG153, BAD 2024 and AEDV 2022 position calcipotriol as a steroid-sparing agent once disease is controlled by topical corticosteroids: after 2-4 weeks of steroid the regimen switches to calcipotriol, then to 1-2 applications per week for remission maintenance. 2020 reports efficacy comparable to mid-potency topical steroids for monotherapy of moderate psoriasis.

Sources

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Calcipotriol as «steroid-free» monotherapy for scalp and severe psoriasis

Not recommended

Calcipotriol is a synthetic vitamin D3 analogue, not a «natural» alternative to steroids. The marketing claim of «steroid-free monotherapy for any psoriasis» misleads in severe forms and non-standard sites. For scalp psoriasis, the fixed calcipotriol+betamethasone combination (Daivobet gel, Enstilar foam) is effective; calcipotriol monotherapy is insufficient ( CG153, BAD 2024). On the face and in flexures, calcipotriol is strongly irritating and is not used. In severe psoriasis (PASI above 10, BSA above 10%) any topical therapy is inadequate – phototherapy, methotrexate, ciclosporin, apremilast or biologics are needed. Use of more than 100 g of cream per week for prolonged periods is linked to hypercalcaemia risk. If calcipotriol was prescribed as standalone monotherapy for scalp, flexural or severe psoriasis, consider seeking a second opinion.

Sources

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Official sources

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AEMPS / CIMA

Spanish Medicines Information Centre (CIMA)

Label dated: 04/08/2025

Safety

Contraindications

Hypersensitivity to calcipotriol
Calcium metabolism disorders (hypercalcaemia, hypercalciuria)
Severe renal or hepatic impairment
Application on the face
Scalp psoriasis as monotherapy (without steroid) – ineffective
Doses above 100 g of cream per week

Serious adverse effects

Hypercalcaemia and hypercalciuria with doses above 100 g of cream per week or coverage above 30% body surface
Increased UV sensitivity
Severe irritant dermatitis on the face or mucosa

Common adverse effects

Local irritation, burning and itching in the first weeks of use
Erythema and skin dryness
Psoriasis flare at plaque margins
Contact dermatitis

PregnancyFDA C

FDA Category C. Systemic absorption through skin at standard topical doses is minimal. AEMPS permits use in pregnancy when there is clear clinical benefit and the affected area is below 10% body surface; SEGO prefers low- and mid-potency topical corticosteroids because more pregnancy data are available.

Breastfeeding

Hale L3. Systemic absorption is minimal. Do not apply to the breast or nipple area before feeding to avoid direct skin contact with the infant. Use on other sites is compatible with breastfeeding.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Calcipotriol used for?

Calcipotriol is evaluated for the following indications with varying evidence strength: Plaque psoriasis (evidence tier A), Calcipotriol as «steroid-free» monotherapy for scalp and severe psoriasis (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Calcipotriol?

Common side effects of Calcipotriol (≥ 1 in 100): Local irritation, burning and itching in the first weeks of use, Erythema and skin dryness, Psoriasis flare at plaque margins, Contact dermatitis. See the Safety section for uncommon and serious reactions.

Is Calcipotriol safe during pregnancy?

FDA category C. FDA Category C. Systemic absorption through skin at standard topical doses is minimal. AEMPS permits use in pregnancy when there is clear clinical benefit and the affected area is below 10% body surface; SEGO prefers low- and mid-potency topical corticosteroids because more pregnancy data are available.

Is Calcipotriol compatible with breastfeeding?

Hale L3. Systemic absorption is minimal. Do not apply to the breast or nipple area before feeding to avoid direct skin contact with the infant. Use on other sites is compatible with breastfeeding.

Who should not take Calcipotriol?

Calcipotriol is contraindicated in: Hypersensitivity to calcipotriol; Calcium metabolism disorders (hypercalcaemia, hypercalciuria); Severe renal or hepatic impairment; Application on the face; Scalp psoriasis as monotherapy (without steroid) – ineffective. Full list in the Safety section.

Mechanism of action

Indications

Plaque psoriasis

Second line

Sources

Safety

Contraindications

Hypersensitivity to calcipotriol
Calcium metabolism disorders (hypercalcaemia, hypercalciuria)
Severe renal or hepatic impairment
Application on the face
Scalp psoriasis as monotherapy (without steroid) – ineffective
Doses above 100 g of cream per week

Serious adverse effects

Hypercalcaemia and hypercalciuria with doses above 100 g of cream per week or coverage above 30% body surface
Increased UV sensitivity
Severe irritant dermatitis on the face or mucosa

Common adverse effects

Local irritation, burning and itching in the first weeks of use
Erythema and skin dryness
Psoriasis flare at plaque margins
Contact dermatitis

PregnancyFDA C

Breastfeeding

Hale L3. Systemic absorption is minimal. Do not apply to the breast or nipple area before feeding to avoid direct skin contact with the infant. Use on other sites is compatible with breastfeeding.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Calcipotriol used for?

What are the side effects of Calcipotriol?

Is Calcipotriol safe during pregnancy?

Is Calcipotriol compatible with breastfeeding?

Hale L3. Systemic absorption is minimal. Do not apply to the breast or nipple area before feeding to avoid direct skin contact with the infant. Use on other sites is compatible with breastfeeding.

Who should not take Calcipotriol?