ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Combination Topical — Psoriasis Pregnancy: Avoid — calcipotriol (limited data) and betamethasone (risk of fetal adrenal suppression); use plain topical steroids or emollients in pregnancy

Calcipotriol / Betamethasone Dipropionate

Brand names: Dovobet (ointment/gel), Enstilar (foam), Xamiol (gel)

Adult dose

Dose: Ointment/gel: apply to affected area once daily. Foam (Enstilar): apply to affected area once daily
Route: Topical
Frequency: Once daily
Max: Calcipotriol max 5 g/week (hypercalcaemia risk); betamethasone limits as per potent steroid guidance
Fixed-dose combination of calcipotriol 50 mcg/g (vitamin D analogue) + betamethasone dipropionate 0.5 mg/g (potent corticosteroid). More effective than either component alone. Used for body and scalp psoriasis. Enstilar foam preferred for scalp — easier application. Maximum treatment area 30% BSA.

Paediatric dose

Dose: Apply thin layer to affected area once daily topical/kg
Route: Topical
Frequency: Once daily
Max: Not recommended under 18 years (Enstilar); Dovobet licensed from 12 years in some countries — specialist guidance
BNFc: calcipotriol/betamethasone combination — licensed from 12 years in psoriasis (Dovobet); Enstilar not licensed under 18 years. Limit use on face and flexures.

Dose adjustments

Renal

Use with caution — calcipotriol may increase calcium absorption in renal impairment

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNFc: calcipotriol/betamethasone combination — licensed from 12 years in psoriasis (Dovobet); Enstilar not licensed under 18 years. Limit use on face and flexures.

Clinical pearls

  • Most widely prescribed topical treatment for plaque psoriasis in UK — combination superior to either component alone (additive anti-inflammatory + keratinocyte normalisation)
  • Enstilar aerosol foam: superior delivery to scalp and hairy areas; leaves no residue; once-daily application improves adherence vs split-product regimen
  • Calcipotriol max 100 g/week (MHRA): exceeding this risks hypercalcaemia — check serum calcium if patient using large amounts
  • Proactive therapy: once weekly application of calcipotriol/betamethasone to previously affected areas reduces relapse rate (PRESTO trial)
  • Do not use on face or flexures with potent steroids — use plain calcipotriol or mild steroid in these areas
  • BAD Psoriasis Pathway: calcipotriol/betamethasone combination is first-line topical for plaque psoriasis (step 1 before phototherapy or systemic therapy)

Contraindications

  • Erythrodermic or pustular psoriasis
  • Calcium metabolism disorders (hypercalcaemia)
  • Skin infections
  • Rosacea or perioral dermatitis
  • Face or intertriginous areas (long-term)

Side effects

  • Local skin irritation (calcipotriol component)
  • Skin atrophy and striae (betamethasone component — prolonged use)
  • Hypercalcaemia (excessive use — monitor if >100 g/week)
  • HPA axis suppression (extensive use)
  • Rebound flare on withdrawal

Interactions

  • Salicylic acid — degrades calcipotriol; do not use simultaneously (apply at different times)

Monitoring

  • Serum calcium (if using >100 g/week)
  • Skin response at 4 weeks
  • HPA axis (if large area use)
  • Growth in children

Reference: BNFc; BNF 90; BNFc; BAD Psoriasis Guidelines 2017; PRESTO Trial (Lebwohl et al. 2005); NICE NG10 (Psoriasis). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways