Vitamin D analogue + potent corticosteroid Pregnancy: No adequate data in pregnant women; during pregnancy should only be used when the potential benefit justifies the potential risk. Breast-feeding: betamethasone passes into breast milk (adverse effect on the infant seems unlikely at therapeutic doses), no data on calcipotriol excretion — use with caution and do not apply to the breast when breast-feeding.

Calcipotriol with betamethasone

Brand names: Dovobet, Enstilar, Wynzora

A topical fixed-combination of the vitamin D analogue calcipotriol with the potent corticosteroid betamethasone, used once daily for plaque psoriasis affecting the trunk, limbs and scalp.

Adult dose

Dose: Apply to affected areas once daily

Route: Topical (cutaneous use)

Frequency: Once daily (may be more convenient in the evening); the gel should remain on the skin during the night or during the day

Max: When using calcipotriol-containing medicinal products the maximum daily dose should not exceed 15 g, and the body surface area treated with calcipotriol-containing products should not exceed 30%. If other calcipotriol-containing products are used, the total across all of them must not exceed 15 g per day.

Source product: Calcipotriol/Betamethasone 50 micrograms/g + 0.5 mg/g gel (UK SPC §4.2). Recommended treatment period is 4 weeks for scalp areas and 8 weeks for non-scalp areas; if it is necessary to continue or restart treatment after this period, treatment should be continued after medical review and under regular medical supervision (the physician may decide on a different treatment period or on repeated treatment). Scalp application: all affected scalp areas may be treated; usually an amount between 1 g and 4 g per day is sufficient (4 g corresponds to one teaspoon). Apply with the fingertips and rub in gently until covered by a thin layer; use only on psoriatic skin, not on unaffected skin. The gel should not be applied directly to the face or eyes; skin of the face and genitals is very sensitive to corticosteroids and the product should not be used in these areas. Do not bandage, tightly cover or wrap the treated area. Wash hands after use. For optimal effect it is recommended not to shower, bathe or wash the hair immediately after application. Shake the tube before use. PAEDIATRIC: the SPC states the safety and efficacy of Calcipotriol/Betamethasone in children and adolescents below 18 years have not been established; data in adolescents aged 12 to 17 years are described in sections 4.8 and 5.1 but no recommendation on a posology can be made — no paediatric dose is given in the source.

Dose adjustments

Renal

The safety and efficacy in patients with severe renal insufficiency or severe hepatic disorders have not been evaluated (no dose adjustment stated in the SPC).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients
Erythrodermic, exfoliative and pustular psoriasis
Known disorders of calcium metabolism (due to the calcipotriol content)
Due to the corticosteroid content: viral (e.g. herpes or varicella) skin lesions, fungal or bacterial skin infections, parasitic infections, skin manifestations in relation to tuberculosis
Due to the corticosteroid content: perioral dermatitis, atrophic skin, striae atrophicae, fragility of skin veins, ichthyosis, acne vulgaris, acne rosacea, rosacea, ulcers and wounds

Side effects

Pruritus (most frequently reported adverse reaction) — common
Exacerbation of psoriasis, dermatitis, erythema, rash, acne — uncommon
Skin burning sensation, skin irritation, dry skin, application site pain — uncommon
Skin infection (bacterial, fungal, viral) and folliculitis; eye irritation — uncommon
Skin striae, skin exfoliation, hypersensitivity, rebound effect — rare; blurred vision and hair colour changes — frequency not known
Class effects: systemic corticosteroid effects (adrenocortical suppression, cataract, raised intra-ocular pressure, effect on diabetic control), and hypercalcaemia/hypercalciuria very rarely from calcipotriol

Clinical monograph

How it works

Calcipotriol acts on the vitamin D receptor to regulate excessive keratinocyte proliferation and differentiation, while betamethasone provides anti-inflammatory and immunosuppressive effects, giving complementary plaque clearance.

Prescribing in practice

Restrict the weekly quantity and the treated surface area, since excessive calcipotriol absorption can cause hypercalcaemia and the potent corticosteroid adds risks of skin atrophy and adrenal suppression.
Avoid the face, flexures, broken skin and occlusion.
Not indicated for guttate, erythrodermic or generalised pustular psoriasis.

Monitoring

Reassess the plaques periodically and stay within the recommended maximum weekly amount to limit hypercalcaemia and corticosteroid effects.

Counselling the patient

Use once daily on the affected patches only, avoiding healthy skin and the face.
Wash your hands after applying and do not use more than the weekly limit advised.

Evidence & guidelines

NICE recommends a combined potent corticosteroid and vitamin D analogue as first-line topical treatment for plaque psoriasis on the body.

Reference: NICE CG153; BAD; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways