Psoriasis Australia

Vitamin D Analogues

Vitamin D analogues are synthetic compounds that mimic the effects of natural vitamin D in the body.

Overview of Vitamin D analogues

Vitamin D analogues are commonly used in the treatment of psoriasis due to their ability to regulate skin cell production and reduce inflammation. By slowing down the rapid growth of skin cells and encouraging normal cell turnover, Vitamin D analogues help to clear psoriatic plaques and reduce scaling.

How Vitamin D Analogues Work

Psoriasis is characterized by the rapid proliferation of skin cells, leading to the formation of thick, scaly plaques. Vitamin D analogues work by binding to vitamin D receptors in the skin, which:

  • Inhibit Keratinocyte Proliferation: Slowing down the rapid growth of skin cells.
  • Promote Differentiation: Encouraging the maturation of keratinocytes (skin cells) into their normal, non-proliferative state.
  • Reduce Inflammation: By modulating the immune response, Vitamin D analogues help to decrease the inflammatory processes associated with psoriasis.

Common Vitamin D Analogues

1. Calcipotriol (Calcipotriene)

  • Forms: Creams, ointments, and scalp solutions.
  • Common Brands:
  • Uses: Calcipotriol is often prescribed for mild to moderate plaque psoriasis and is particularly effective when used on the body.

2. Calcitriol

  • Forms: Ointments.
  • Common Brands: 
  • Uses: Calcitriol is slightly less irritating than calcipotriol, making it suitable for sensitive areas like the face and skin folds.

3. Tacalcitol

    • Forms: Ointments.
    • Common Brands:
    • Uses: Tacalcitol is another vitamin D analogue used in treating mild to moderate psoriasis, particularly for patients who may not tolerate other forms.

Usage Guidelines

Vitamin D analogues are usually applied once or twice daily, depending on the specific product and the severity of the psoriasis. Here are some key considerations for their use:

  • Application: Apply a thin layer to the affected area, avoiding healthy skin as much as possible. Ensure the skin is clean and dry before application.
  • Combination Therapy: Vitamin D analogues are often used in combination with corticosteroids. This combination can be more effective than either treatment alone and may reduce the need for higher doses of steroids, thereby minimizing side effects.
  • Scalp Psoriasis: For scalp psoriasis, Vitamin D analogue solutions or lotions are applied directly to the scalp, often before bed, to help reduce scaling and inflammation.

Benefits of Vitamin D Analogues

Vitamin D analogues are favored for their effectiveness in treating psoriasis while minimizing some of the side effects associated with other topical treatments, such as corticosteroids. Some benefits include:

  • Long-Term Use: They are generally safe for long-term use, unlike potent corticosteroids which are limited by their potential side effects.
  • Minimal Skin Thinning: Unlike corticosteroids, Vitamin D analogues do not cause skin thinning (atrophy), making them a safer option for sensitive areas and prolonged treatment.
  • Flexibility: Suitable for use on various parts of the body, including the face and folds, though with caution in areas prone to irritation.

Potential Side Effects

Although Vitamin D analogues are generally well-tolerated, they can cause side effects, particularly if used improperly:

  1. Skin Irritation: Redness, itching, and a burning sensation can occur, especially when used on sensitive areas or in excessive amounts.
  2. Hypercalcemia: Although rare, overuse of Vitamin D analogues can lead to elevated levels of calcium in the blood (hypercalcemia), particularly when applied over large areas of the body or in combination with other systemic Vitamin D sources.
  3. Photosensitivity: These treatments can make the skin more sensitive to sunlight, increasing the risk of sunburn. It is recommended to use sunscreen and avoid excessive sun exposure when using Vitamin D analogues.

Special Considerations

  • Children: Vitamin D analogues are generally considered safe for use in children, though lower concentrations or formulations may be recommended.
  • Pregnancy and Breastfeeding: While considered safe for use during pregnancy and breastfeeding, it is important to consult a healthcare provider to ensure appropriate use.
  • Sensitive Areas: Use caution when applying Vitamin D analogues to sensitive skin areas, as these regions are more prone to irritation.

Combining Vitamin D Analogues with Other Treatments

Combining Vitamin D analogues with other topical treatments can enhance their effectiveness and help manage psoriasis more effectively:

  • Corticosteroids + Vitamin D Analogues: This combination is commonly used to maximize efficacy while minimizing side effects. Often, a corticosteroid is applied in the morning, and the Vitamin D analogue in the evening.
  • Emollients: Using emollients alongside Vitamin D analogues can help maintain skin hydration and improve the overall effectiveness of the treatment.

Accessing Vitamin D Analogues in Australia

In Australia, Vitamin D analogues are available by prescription, and they are often covered under the Pharmaceutical Benefits Scheme (PBS), making them more accessible and affordable for patients. It’s important to consult with a healthcare provider to determine the most appropriate treatment plan and ensure proper use.

Summary

Vitamin D analogues are a cornerstone in the management of psoriasis, offering a safe and effective option for reducing symptoms and improving skin health. By understanding their benefits, usage guidelines, and potential side effects, patients can better manage their psoriasis and achieve better treatment outcomes.