title: Intra-individual comparison of the cutaneous safety and efficacy of calcitriol 3 microg g(-1) ointment and calcipotriol 50 microg g(-1) ointment on chronic plaque psoriasis localized in facial, hairline, retroauricular or flexural areas.
abstract: BACKGROUND
  Psoriasis involving sensitive skin areas remains difficult to treat because of the side-effects of topical corticosteroids and the irritancy potential of vitamin D3 derivatives. Several clinical trials have demonstrated that calcitriol, the naturally occurring and hormonally active form of vitamin D3, is effective and safe at the dose of 3 microg g(-1) for the treatment of psoriasis affecting the trunk and limbs.
  
  
  METHODS
  We compared the safety and efficacy of calcitriol 3 microg g(-1) ointment and calcipotriol 50 microg g(-1) ointment in a multicentre, randomized, investigator-blinded, left-right comparison in mild to moderate chronic plaque psoriasis affecting sensitive areas, defined as being the face, hairline, retroauricular and flexural areas. One pair of symmetrical and bilateral target lesions was selected from each area and assessed for perilesional erythema, oedema, and stinging/burning. Global assessment of local tolerability and global improvement were rated by the investigator, and the subjects were asked to evaluate the tolerability and efficacy of each product and to express their global preference.
  
  
  RESULTS
  In the 75 subjects, calcitriol and calcipotriol both led to clearing of at least one target lesion in 21 (28%) of the subjects each. Perilesional erythema (P < 0.001), perilesional oedema (P < 0.02) and stinging/burning (P < 0.001) were all significantly less severe with calcitriol than with calcipotriol. The subjects' evaluation of local tolerability was significantly (P < 0.0001) in favour of calcitriol. Ten treatment-related dermatological events occurred in eight subjects, including one subject who experienced skin discomfort on both sides. All other events occurred only on the calcipotriol-treated side (irritant dermatitis, six subjects; contact dermatitis, one subject). Global assessment of improvement from baseline by the investigators was significantly greater for the calcitriol-treated lesions (P < 0.02). The subjects' global preference was significantly in favour of calcitriol (P < 0.02).
  
  
  CONCLUSIONS
  In the present study, calcitriol ointment was found to be better tolerated and would appear to be more effective than calcipotriol ointment in the treatment of psoriasis in sensitive areas.
authors.affiliation: Hôpital de l'Archet 2, Nice, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Ortonne
authors.forename: P
authors.initials: P
authors.lastname: Humbert
authors.forename: J F
authors.initials: JF
authors.lastname: Nicolas
authors.forename: N
authors.initials: N
authors.lastname: Tsankov
authors.forename: S D
authors.initials: SD
authors.lastname: Tonev
authors.forename: A
authors.initials: A
authors.lastname: Janin
authors.forename: J
authors.initials: J
authors.lastname: Czernielewski
authors.forename: M
authors.initials: M
authors.lastname: Lahfa
authors.forename: L
authors.initials: L
authors.lastname: Dubertret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla; D002117:Calcitriol / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004311:Double-Blind Method; D004361:Drug Tolerance; D004431:Ear, External; D004487:Edema / Q000139:chemically induced; D004890:Erythema / Q000139:chemically induced; D005148:Facial Dermatoses / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments; D017060:Patient Satisfaction; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D009824:Ointments; C055085:calcipotriene; D002117:Calcitriol