Photosensitivity associated with combined UV-B and calcipotriene therapy

McKenna, K. E.

doi:10.1001/archderm.131.11.1305

Cited by 13 publications

(6 citation statements)

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“…Photosensitization has been reported in patients treated with UVB phototherapy after addition of topical calcipotriol. 19 In our study, no such reactions were expected, as subjects who were included were not receiving any form of phototherapy. However, these results confirm that calcipotriol and UVB can be combined safely.…”

Section: Discussionmentioning

confidence: 65%

Calcipotriol ointment and cream or their vehicles applied immediately before irradiation inhibit ultraviolet B-induced erythema

Rie

Nuzzo

Brands

et al. 2000

British Journal of Dermatology

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Results of ultraviolet (UV) B phototherapy can be improved by the application of calcipotriol, but studies are needed to decide how the two treatments should be combined. We studied the effect of UVB after application of calcipotriol ointment (50 microg g-1) and calcipotriol cream (50 microg g-1) and determined the optimal time of application of calcipotriol when combined with UVB phototherapy (280-350 nm), in a single-blinded randomized vehicle-controlled study of 37 healthy adult volunteers. Calcipotriol ointment or cream was applied randomly on five areas on the back at different time intervals from UVB irradiation. One area was left untreated as the control. Application times were the evening before, the morning before, 2 h before, immediately before, and immediately after irradiation. UVB irradiation was administered by TL20W/12 fluorescent tube lamps at increasing doses (20, 25, 32, 40, 50 and 64 mJ cm-2) to six subunits of each test area. Clinical assessment was performed 24 h after UVB irradiation by a blinded investigator. Calcipotriol ointment and cream were applied in 19 and 18 subjects, respectively, and erythema was measured for each application time quantified. We found that erythemal reactions were significantly smaller when calcipotriol ointment or cream was applied immediately before irradiation compared with all other application times. To explain these findings, a vehicle control study was performed. No difference in erythema was seen between calcipotriol medication and the vehicle controls. Spectrophotometric analysis of the calcipotriol cream and ointment showed no UV absorbance in the UVB range. No signs of photosensitization were noted. In conclusion, the vehicles of the calcipotriol ointment and cream inhibit the induction of erythema by UVB irradiation if applied immediately before phototherapy. Consequently, calcipotriol ointment and cream should not be applied directly before UVB irradiation; however, they may be applied at any time up to 2 h prior to or immediately after UVB irradiation. Possible explanations for this sunscreen activity are discussed.

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Section: Discussionmentioning

confidence: 65%

Calcipotriol ointment and cream or their vehicles applied immediately before irradiation inhibit ultraviolet B-induced erythema

Rie

Nuzzo

Brands

et al. 2000

British Journal of Dermatology

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“…If calcipotriol is added to ongoing UVB treatment, which is not effective enough by itself, there seems to be an obvious risk of skin irritation. Burn reactions have been reported in 4 patients who received UVB phototherapy and subsequently began treatment with calcipotriol ointment [22]. This irritation can be avoided if the UVB doses are temporarily decreased.…”

Section: Discussionmentioning

confidence: 99%

Topical Calcipotriol Combined with Phototherapy for Psoriasis

Molin

1999

Dermatology

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Background: Calcipotrial has a well-documented effect in the treatment of psoriasis. Objective: To confirm the beneficial effect of the combination of calcipotriol and UVB and to demonstrate that the combination is safe and well tolerated. Methods: Data from two randomized right/left studies were analysed. Patients included in the studies had chronic stable plaque-type psoriasis with symmetrical lesions on the arms, the legs and/or the trunk. In one study, 101 patients were treated with calcipotriol on one side and calcipotriol + UVB on the other side of the body (open study). In the other study, 77 patients were treated with calcipotriol + UVB on one side and vehicle + UVB on the other side of the body (double-blind study). Calcipotriol ointment, 50 μg/g, was applied twice daily and UVB 3 times weekly for 8 weeks. UVB was increased from 0.7 MED before treatment in rapid steps up to the erythema threshold. Result: In both treatment series the therapeutic effect of the combination of calcipotriol and UVB was enhanced as compared to calcipotriol alone and UVB alone. In the first series there was a significant reduction of the psoriasis area and severity index (PASI) with the combination after 2 weeks as compared to calcipotriol alone. At the end of treatment significantly more sides were cleared after calcipotriol + UVB than after calcipotriol alone. In the other series there was a significantly faster onset of improvement on the sides treated with calcipotriol + UVB than on those treated with vehicle + UVB. After 2 weeks there was a significant difference in PASI in favour of calcipotriol + UVB. At the end of treatment, however, there was no difference between the treatments. There was a similar adverse event profile with either treatment. The addition of UVB to calcipotriol did not alter the tolerability or safety of topically applied calcipotriol. Conclusions: The result indicates a beneficial effect of combining calcipotriol and phototherapy. The findings are compared to other published studies.

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“…The lack of photosensitivity associated with the tazarotene and UVB combination suggests a clinical advantage over a calcipotriol and UVB phototherapy combination, as the latter combination has been reported to be associated with photosensitivity. 4 The preliminary data from this study demonstrate that the addition of tazarotene treatment to UVB phototherapy achieves consistently greater reductions in the elevation and scaling of difficult-to-treat psoriatic plaques than UVB phototherapy alone or UVB phototherapy plus vehicle gel. Furthermore, the addition of tazarotene to UVB phototherapy enables treatment success (Ն 50% global improvement in psoriatic lesions) to be achieved in less than half the time needed with phototherapy alone or in combination with vehicle gel.…”

Section: Discussionmentioning

confidence: 69%

“…3,9 Similarly, treatment with phototherapy and calcipotriol has been associated with photosensitivity, necessitating caution when introducing calcipotriol to patients who are already established on UVB therapy. 4 Although combination therapy with oral retinoids, such as etretinate or acitretin, is known to enhance the efficacy of phototherapy, 5,7,8 the prolonged use of such drugs is associated with a host of undesirable adverse effects including dry skin, headaches, arthralgias, bone pain, hyperostosis and teratogenicity. 6,[10][11][12] In addition, an increased risk of UVBor PUVA-induced erythema with oral etretinate or isotretinoin necessitates increasing the dose of ultraviolet radiation more gradually in patients who are receiving these drugs than in those who are not.…”

mentioning

confidence: 99%

Optimizing therapy: tazarotene in combination with phototherapy

Lowe

1999

Br J Dermatol

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Phototherapy is often used in combination with other antipsoriatic treatments in an attempt to improve efficacy and reduce patients' cumulative exposure to radiation. Although this aim has been achieved with some combinations, the additional therapies often introduce a potential risk of other tolerability and safety problems. The efficacy of tazarotene reported in clinical trials to date suggest that this drug may help to improve the efficacy of phototherapy, and perhaps reduce the ultraviolet light exposure required without introducing additional, clinically significant problems. Preliminary results from the first 10 patients in a clinical trial investigating such combination therapy are reported here. They demonstrate that the addition of tazarotene to UVB phototherapy increases the percentage of patients achieving treatment success (> or = 50% global improvement in psoriasis) from 60% to 100% at Day 81. The UVB plus tazarotene combination achieved consistently greater reductions in the elevation and scaling of difficult-to-treat psoriatic plaques than UVB phototherapy alone or UVB phototherapy plus vehicle gel. The tazarotene combination therapy also achieved initial treatment success in less than half the time needed with phototherapy alone (median of 32 vs. 67 days). Combining UVB phototherapy with tazarotene treatment appears to offer a valuable therapeutic option that is more efficacious and faster than UVB phototherapy alone.

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Photosensitivity associated with combined UV-B and calcipotriene therapy

Cited by 13 publications

References 0 publications

Calcipotriol ointment and cream or their vehicles applied immediately before irradiation inhibit ultraviolet B-induced erythema

Calcipotriol ointment and cream or their vehicles applied immediately before irradiation inhibit ultraviolet B-induced erythema

Topical Calcipotriol Combined with Phototherapy for Psoriasis

Optimizing therapy: tazarotene in combination with phototherapy

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