Calcipotriol ointment shows comparable efficacy to topical steroids in chronic hand eczema

Abstract

Topical potent corticosteroids are the mainstay of treatment for chronic hand eczema (CHE). However, there are numerous adverse effects associated with the chronic use of topical corticosteroids. Calcipotriol has been widely used in psoriasis and has been reported to achieve beneficial effects in several inflammatory diseases. This study aimed to evaluate the efficacy and safety of calcipotriol ointment compared to desoximetasone ointment in the treatment of CHE. Patch testing was performed in all recruited subjects. Then, each hand of the patient was randomly allocated for the application of either calcipotriol ointment or desoximetasone ointment twice daily for 8 weeks. Recurrence was assessed 4 weeks after discontinuation of the treatment. The Hand eczema severity index (HECSI) scores, quartile grading assessments and digital photographs were evaluated. Adverse reactions were also monitored. A total of 13 participants completed the protocol. Mean HECSI scores revealed up to a 75% reduction in both treatments (p < .001) without significant differences between the groups (p > .05). Approximately 70% of the subjects reported more than 75% improvement with calcipotriol at the end of the treatment. Mild scaling and mild dryness were the most common reactions found with calcipotriol and desoximetasone, respectively. In conclusion, calcipotriol ointment is safe and as effective as desoximetasone ointment. Calcipotriol ointment may be an alternative treatment option for CHE.

Drugs for the Treatment of Chronic Hand Eczema: Successes and Key Challenges

“…39,54,55 Calcipotriol affects epidermal cells by prohibiting proliferation, angiogenesis, and cytokine production, and regulates hapten-induced immune responses by dendritic cells, 1,39,54 but its widespread use is limited by common side effects such as skin scaling, dryness, and irritation. 55,56 Case reports of several patients have shown improvements in hand eczema after treatment with topical calcipotriol, 39,54 and a recent prospective, randomized trial found that 0.005% calcipotriol was as effective as topical steroids in improving clinical severity of hand eczema. 55 Calcineurin inhibitors, another class of existing topicals, are frequently used in the treatment of mild to moderate chronic hand eczema.…”

Hand eczema: treatment

“…A recent prospective study in 13 patients with in-patient control compared the efficacy of calcipotriol ointment with desoximetasone ointment, a superpotent glucocorticosteroid, twice daily for 8 weeks. 43 The hand eczema severity index (HECSI) scores revealed up to a 75% reduction in both treatments (P < 0.001) without significant differences between the groups (P > 0.05). 43 Thus, calcipotriol may have a potential as a steroid-sparing agent in the management of hand eczema.…”

“…43 The hand eczema severity index (HECSI) scores revealed up to a 75% reduction in both treatments (P < 0.001) without significant differences between the groups (P > 0.05). 43 Thus, calcipotriol may have a potential as a steroid-sparing agent in the management of hand eczema. Clearly, further studies are necessary including more patients and differentiating better between hand eczema and psoriasis.…”

“…Anecdotal evidence exists on its use in hyperkeratotic hand eczema that may mimic palmar psoriasis 41,42 ; its use for this condition would be also off-label. 43 Thus, calcipotriol may have a potential as a steroid-sparing agent in the management of hand eczema. 43 The hand eczema severity index (HECSI) scores revealed up to a 75% reduction in both treatments (P < 0.001) without significant differences between the groups (P > 0.05).…”

Handekzem – wieder von Interesse

“…Es wird diskutiert, dass die Behandlungszeit im Therapiearm zu kurz gewählt worden war [10]. Calcipotriol, als topisches Therapeutikum bei Psoriasis bekannt, konnte beim CHE bei allen klinischen Typen gute Wirkung zeigen [11]. Bei atopischem Handekzem mit Therapieversagen auf die üblichen systemischen Immunsuppressiva der bisherigen Leitlinie war Dupilumab effektiv.…”