Combination Topical — Psoriasis Pregnancy: No adequate data in pregnant women - during pregnancy use only when the potential benefit justifies the potential risk. Betamethasone passes into breast milk but adverse effects on the infant seem unlikely at therapeutic doses; exercise caution in breast-feeding women and do not apply to the breast (UK SPC §4.6)

Calcipotriol / Betamethasone Dipropionate

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

A topical fixed-combination of the vitamin D analogue calcipotriol with the potent corticosteroid betamethasone dipropionate, used as a once-daily treatment for plaque psoriasis of the body and scalp.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Apply a thin layer to the affected areas (scalp: usually 1 g to 4 g per day; 4 g corresponds to one teaspoon)

Route: Topical (cutaneous)

Frequency: Once daily

Max: When using calcipotriol-containing medicinal products the maximum daily dose should not exceed 15 g, and the body surface area treated should not exceed 30%

UK SPC: Calcipotriol/Betamethasone 50 micrograms/g + 0.5 mg/g gel. 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, this should follow medical review and be under regular medical supervision. If other calcipotriol-containing products are used concurrently, the total calcipotriol product amount must not exceed 15 g per day. The gel should remain on the skin during the night or during the day; it is recommended not to shower, bathe or wash the hair immediately after application. Do not apply directly to the face or eyes; the 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; avoid occlusive dressings (they increase systemic corticosteroid absorption). Shake the tube before use and wash hands after application. Concurrent treatment with other steroids on the same treatment area must be avoided (contains a potent group III steroid). Paediatric: safety and efficacy in children and adolescents below 18 years have not been established; data are available in adolescents aged 12 to 17 years but no recommendation on a posology can be made.

Dose adjustments

Renal

Safety and efficacy have not been evaluated in patients with severe renal insufficiency or severe hepatic disorders (UK SPC §4.2)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. 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)
Viral (e.g. herpes or varicella) lesions of the skin, fungal or bacterial skin infections, parasitic infections, and skin manifestations in relation to tuberculosis
Perioral dermatitis, atrophic skin, striae atrophicae, fragility of skin veins, ichthyosis, acne vulgaris, acne rosacea, rosacea, ulcers and wounds

Side effects

Pruritus (common; most frequently reported)
Exacerbation of psoriasis, dermatitis, erythema, rash, acne, skin burning sensation, skin irritation, dry skin (uncommon)
Skin infection (bacterial, fungal, viral) and folliculitis (uncommon)
Eye irritation (uncommon); vision blurred (frequency not known)
Application site pain including burning (uncommon); rebound effect (rare)
Skin striae and skin exfoliation (rare); hypersensitivity (rare); hypercalcaemia or hypercalciuria if the maximum daily dose is exceeded

Clinical monograph

How it works

Calcipotriol binds the vitamin D receptor to normalise keratinocyte proliferation and differentiation, while betamethasone dipropionate provides anti-inflammatory and immunosuppressive action, the two components acting synergistically on plaques.

Prescribing in practice

Limit the total amount applied and the body-surface area treated, because excess calcipotriol can disturb calcium balance and cause hypercalcaemia, and the potent steroid adds atrophy and adrenal-suppression risk.
Avoid the face, flexures and broken skin and avoid occlusion.
Not suitable for guttate, erythrodermic or pustular psoriasis.

Monitoring

Review plaque response and keep within recommended weekly application limits to avoid hypercalcaemia and corticosteroid adverse effects, with intermittent rather than continuous long-term use.

Counselling the patient

Apply once daily to the plaques only, not to healthy skin or the face, and wash your hands after use.
Do not exceed the amount you have been told to use in a week.

Evidence & guidelines

NICE recommends a potent corticosteroid plus vitamin D analogue as first-line topical therapy for trunk and limb plaque psoriasis.

Reference: BAD Psoriasis Guidelines 2017; PRESTO Trial (Lebwohl et al. 2005); NICE NG10 (Psoriasis); 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