Calcipotriol / Betamethasone Dipropionate

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.