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Calcipotriol
General Information
Topical calcipotriol (a vitamin D analogue) is an effective
and safe treatment for mild to moderate psoriasis
vulgaris. Its mode of action is identical to that of
1,25-dihydroxycolecalciferol (calcitriol).
Organs and Systems
Nervous system
Calcipotriol can cause headache (SEDA-20, 157).
Mineral balance
With the use of doses larger than the recommended
maximum of 100 g/week, a few reports have documented
hypercalcemia and hypercalciuria (SEDA-18, 176)
(SEDA-22, 172) (1,2). However, hypercalcemia has also
been reported in a few patients using no more than the
recommended doses (3,4). Calcipotriol exerts its effects
on systemic calcium homeostasis by increasing intestinal
absorption of calcium and probably phosphate. This
results in suppression of parathyroid hormone and
1,25-dihydroxycolecalciferol (5).
Skin
At recommended doses, the adverse effects of calcipotriol
are limited to skin reactions. Lesional and perilesional

irritation occurs in about 20% of patients (6). Contact
dermatitis is rare. Photosensitization can occur when calci-
potriol is used in patients undergoing UVB phototherapy.
Contamination of the facial skin can result in frank
irritant contact dermatitis. Allergic contact dermatitis
has been observed in some patients (7–10).
Hyperpigmentation due to local application of vitamin
D in combination with photochemotherapy has been
described. Calcipotriol may have the same potential.
 In one case, there was profound hyperpigmentation
during UVB 311 nm phototherapy in combination
with local calcipotriol, applied after the UVB irradia-
tion (11). Calcipotriol-treated areas, and not the sur-
rounding normal skin, started to show increased
pigmentation after six sessions of irradiation, stabilized
during therapy, and slightly decreased in intensity dur-
ing the 6 months after photochemotherapy had ended.
No photoallergy tests were performed.
Calcipotriol can occasionally convert psoriasis vulgaris
into pustular psoriasis (SEDA-19, 165).
Immunologic
Contact allergic reactions to calcipotriol are rare. In one
case patch tests with Psorcutan Salbe and calcipotriol (its
active ingredient) were both positive (10).
References
1. Fogh K, Kragballe K. Vitamin D3 analogues. Clin Dermatol
1997;15(5):705–13.
2. Berth-Jones J, Bourke JF, Iqbal SJ, Hutchinson PE. Urine
calcium excretion during treatment of psoriasis with topical
calcipotriol. Br J Dermatol 1993;129(4):411–14.
3. Russell S, Young MJ. Hypercalcaemia during treatment of
psoriasis with calcipotriol. Br J Dermatol 1994;130(6):795–6.
4. Kawahara C, Okada Y, Tanikawa T, Fukusima A, Misawa H,
Tanaka Y. Severe hypercalcemia and hypernatremia asso-
ciated with calcipotriol for treatment of psoriasis. J Bone
Miner Metab 2004;22(2):159–62.
5. Bourke JF, Mumford R, Whittaker P, Iqbal SJ, Le Van LW,
Trevellyan A, Hutchinson PE. The effects of topical calcipo-
triol on systemic calcium homeostasis in patients with chronic
plaque psoriasis. J Am Acad Dermatol 1997; 37(6):929–34.
6. Guilhou JJ. Le calcipotriol. [Calcipotriol.] Ann Dermatol
Venereol 2001;128(3 Pt 1):229–37.
7. de Groot AC. Contact allergy to calcipotriol. Contact
Dermatitis 1994;30(4):242–3.
8. Park YK, Lee JH, Chung WG. Allergic contact dermatitis
from calcipotriol. Acta Derm Venereol 2002;82(1):71–2.
9. Krayenbuhl BH, Elsner P. Allergic and irritant contact
dermatitis to calcipotriol. Am J Contact Dermat
1999;10(2):78–80.
10. Frosch PJ, Rustemeyer T. Contact allergy to calcipotriol
does exist. Report of an unequivocal case and review of
the literature. Contact Dermatitis 1999; 40(2):66–71.
11. Rutter A, Schwarz T. Ausgeprägte Hyperpigmentierung
in psoriatischen Plaques als Folge einer
Kombinationsbehandlung mit UVB-311 nm und
Calcipotriol. [Market hyperpigmentation in psoriatic plaque
as a sequelae of combination therapy with UVB-311 and
calcipotriol.] Hautarzt 2000;51(6):431–3.
ª 2006 Elsevier B.V. All rights reserved.
Calcitonin 595
Calcitetracemate
General Information
The use of calcitetracemate in the treatment of lead poison-
ing has been described (1). Between 1993 and 2000, 45
adult patients consulted the Poison Centre of Marseilles,
France after lead exposure (9 women, 36 men, average age
44, range 22–76 years). In 22 patients, a calcitetracemate
provocation test was negative. Six patients with a positive
test refused to be treated; the other 16 were treated with a
total of 58 courses of calcitetracemate by infusion 500 mg
bd for 5 days. The mean blood lead concentration in these
16 patients was 566, range 320–943 ng/ml; the mean urinary
lead excretion was 3011, range 789–7229 mg/day. The mean
amount of lead eliminated in the urine during chelation
therapy was 30 912 mg. In 12 patients in whom lead expo-
sure ended after the diagnosis of lead poisoning, chelation
therapy reduced the blood lead concentration by 69%. In
four patients in whom exposure continued during treat-
ment, the blood lead concentration fell by only 7%. In the
16 treated patients, there was clinical improvement and no
adverse effects of chelation therapy.
Drug Administration
Drug administration route
Lead poisoning in a six-week-old child was treated by
adding disodium calcitetracemate to the peritoneal dialy-
sis fluid (2).
References
1. de Haro L, Prost N, Gambini D, Bourdon JH, Hayek-
Lanthois M, Valli M, Jouglard J, Arditti J. Le saturnisme
des adultes: experience du Centre antipoison de Marseille de
1993 à 2000. [Lead poisoning in adults. Experience of the
Poison Control Center of Marseille from 1993 to 2000.]
Presse Méd 2001;30(37):1817–20.
2. Buneaux F, Protin P, Besson-leaud M, Fabiani P. Rôle du
laboratoire dans le diagnostic et la traitement d’une intoxica-
tion par le plomb. [Role of the laboratory in the diagnosis
and treatment of lead poisoning.] Eur J Toxicol Environ Hyg
1976;9(3):165–70.
Calcitonin
General Information
Calcitonin inhibits osteoclastic bone resorption, increases
the urinary excretion of calcium and phosphate, and
reduces serum calcium. It is established in the treatment
of disorders of high bone turnover, including Paget’s dis-
ease and postmenopausal osteoporosis, but is less effect-
ive than the bisphosphonates. Calcitonin is less effective
than other therapeutic measures in the treatment of acute
hypercalcemia. Long-term administration of calcitonin
reduces morbidity in cases of osteogenesis imperfecta