Calcipotriol/ Betamethasone Dipropionate Ointment

Calcipotriol/Betamethasone Dipropionate ointment is a fixed-dose combination topical medication classified under antipsoriatic agents. It merges a vitamin D analog with a potent corticosteroid, creating a synergistic dual-action therapy used primarily in dermatology for plaque psoriasis management.

This combination was first introduced in Europe in the early 2000s and subsequently approved by the U.S. FDA in 2006. It marked a pivotal shift in psoriasis treatment by simplifying regimens and enhancing adherence.

The ointment delivers precise microgram and milligram concentrations of both agents to ensure effective local activity with minimal systemic exposure.

Formulated in an anhydrous, paraffin-based vehicle, the ointment utilizes mineral oils and synthetic esters to enhance dermal absorption and prolong contact time without maceration.

Typically dispensed in aluminum or laminate tubes ranging from 15g to 120g, many include tamper-evident seals and safety caps to comply with child-resistant standards.

Fluorouracil and calcipotriol are commonly combined to treat actinic keratosis (AK), a skin condition resulting from sun damage. 5FU-Cal therapy proves effective and faster in treatment duration than using just fluorouracil alone.

Clotrimazole and betamethasone dipropionate is a treatment that combines an antifungal agent (clotrimazole) with a cortiсosteroid (betamethasone dipropionate). This medication is commonly used to address skin infections caused by fungi such as athletes foot (tinea pedis), jock itch (tinea cruris), and ringworm (tinea corporis). While clotrimazole works against the infection itself, betamethasone helps alleviate inflammation and associated symptoms, such as redness and itching.

Calcipotriol and calcipotriene are the same drugs. Calcipotriene is the name used in the United States (USAN). They are both derivatives of vitamin D₃ commonly employed in the treatment of psoriasis.

Both calcitriol and calcipotriol are vitamin D analogues commonly used in the treatment of psoriasis; however, they differ in their applications and potential adverse effects. Calcipotriol is mainly administered topically to address plaque psoriasis whereas calcitriol can be administered topically for plaque psoriasis and is also utilized for maintaining calcium balance within the body

Betamethasone dipropionate and triamcinolone acetonide are two types of cortisones commonly prescribed for skin issues, such as eczema and psoriasis. Although they both work well in treating these conditions, betamethasone dipropionate is typically regarded as a steroid compared to triamcinolone acetonide. This implies that it is more efficient in alleviating inflammation, itchiness, and redness; however it also comes with a likelihood of reactions.

Betamethasone dipropionate is commonly viewed as stronger than betamethasone valerate because it can penetrate the skin effectively due to its fat solubility level. This characteristic makes it an effective cortisone treatment for a variety of skin issues. On the other hand, betamethasone valerate is considered a cortisone option, suited for less severe conditions or for individuals who may have greater sensitivity to more potent steroids.

Betamethasone dipropionate and clobetasol are corticosteroid treatments used to address various skin conditions, such as eczema and psoriasis; however, clobetasol is typically regarded as more potent than betamethasone dipropionate in terms of effectiveness for managing these conditions. Both of these medications function by alleviating symptoms by reducing redness and itching while also diminishing swelling in the areas.

Calcipotriol modulates the proliferation and maturation of keratinocytes, directly addressing the hyperproliferative hallmark of psoriatic lesions.

Betamethasone suppresses pro-inflammatory cytokines and cellular infiltration, alleviating erythema, edema, and pruritus at the site of inflammation.

By combining keratinocyte-normalizing and anti-inflammatory effects, the ointment provides faster resolution of plaques with reduced recurrence risk.

Minimal systemic absorption under proper usage conditions. Peak plasma levels of both agents remain well below thresholds associated with systemic adverse effects.

Indicated for the topical treatment of stable, plaque-type psoriasis involving the trunk, limbs, and scalp in adult patients.

Used to complement systemic agents or phototherapy during flares or tapering phases to maintain remission. 

Applied to nail folds and periungual skin for psoriatic nail matrix involvement, showing variable but promising results.

Used with caution in areas prone to occlusion; dose reduction and frequency adjustment recommended.

Preliminary studies suggest benefit in resistant cases of palmoplantar pustulosis and select seborrheic dermatoses.

• Apply once daily, preferably at the same time each day.
• Recommended treatment duration: up to 4 weeks on the body, 8 weeks on the scalp.

Gently massage into affected areas; no rinsing necessary unless instructed. Apply to dry hair and scalp.

• Do not exceed 100g per week.
• Avoid application on more than 30% of body surface area.

Transition to every-other-day application or alternate with non-steroidal emollients after lesion clearance.

If missed, apply as soon as remembered. Do not double dose. Resume regular schedule promptly.

Use with caution due to age-related skin fragility. Monitor for steroid-induced atrophy and adjust frequency as needed.

Generally not recommended for patients under 12 years of age. Use only under strict supervision in adolescents.

Classified as Category C. Use only if potential benefit outweighs fetal risk. Avoid breast application during lactation.

Ensure application sites are not in contact with the infant's skin. Avoid using near the breast or clean the area thoroughly before feeding.

Most reactions are localized, transient, and resolve upon discontinuation or dose reduction.

These effects arise from prolonged corticosteroid exposure and are more common in high-friction areas.

Excessive application may lead to calcium metabolism disturbances and systemic adrenal suppression.

Post-market surveillance indicates a favorable long-term safety profile when used within prescribed limits.

Limit intentional sun exposure. Use sunscreen or protective clothing when outdoors.

Occlusion may enhance systemic absorption and increase the risk of adverse effects. Only use under medical advice.

Abrupt discontinuation may trigger flares. Gradual tapering is recommended after improvement.

Allow at least 30 minutes between application of other topical agents. Avoid concurrent irritants or astringents.

Patients with known hypersensitivity to calcipotriol, betamethasone dipropionate, or any component of the ointment base must not use this product. Hypersensitivity reactions may manifest as localized urticaria, angioedema, or contact dermatitis. In rare cases, systemic allergic responses can occur, necessitating immediate medical attention.

The ointment should not be applied to skin affected by viral conditions (e.g., herpes simplex, varicella), fungal infections (e.g., candidiasis, tinea), or cutaneous tuberculosis. Use in these contexts may exacerbate infection, suppress local immunity, and delay wound healing.

Because calcipotriol is a vitamin D analog, it can influence systemic calcium levels. Patients with pre-existing hypercalcemia, hyperparathyroidism, or chronic kidney disease with calcium-phosphate imbalance should avoid this treatment due to the risk of exacerbating calcium dysregulation.

Application to ulcerated skin, areas of severe dermal atrophy, or thin-skinned zones (e.g., face, groin, axillae) should be avoided. These areas are more susceptible to corticosteroid-related side effects such as striae, telangiectasia, and dermal fragility.

Concurrent use of additional topical corticosteroids or vitamin D derivatives should be avoided unless specifically directed. This can increase the risk of cumulative adverse effects such as skin thinning, tachyphylaxis, or systemic absorption leading to adrenal suppression or hypercalcemia.

Use caution in patients taking thiazide diuretics, high-dose vitamin D, or calcium supplements. These agents may compound the calcium-elevating effect of calcipotriol, potentially leading to clinically significant hypercalcemia or vascular calcification in susceptible individuals.

When using phototherapy (e.g., UVB or PUVA) in conjunction with this ointment, phototoxicity and efficacy must be considered. Sequential application, where the ointment is applied after UV exposure, is generally safer. Applying before phototherapy can reduce treatment efficacy and heighten skin sensitivity.

While no direct contraindication exists, caution is advised when using this ointment alongside systemic agents such as TNF-alpha inhibitors, IL-17 blockers, or systemic retinoids. Immunomodulatory overlap may alter disease dynamics, and patient monitoring should include periodic assessment for systemic side effects or reduced topical responsiveness.

Betamethasone dipropionate alternative

• Clobetasol propionate
• Mometasone furoate 
• Hydrocortisone
• Triamcinolone 

Excessive use, especially over large surface areas or under occlusion, may result in systemic corticosteroid effects such as adrenal suppression, Cushingoid features, hypertension, and hyperglycemia. Cutaneous signs include severe skin thinning, bruising, and striae distensae.

• Nausea and vomiting
• Polyuria and polydipsia
• Muscle weakness and confusion
• Serum calcium levels above 10.5 mg/dL

These indicators necessitate immediate biochemical evaluation and medical intervention.

Upon suspicion of overdose, discontinue the ointment immediately. Initiate supportive measures such as hydration, electrolyte correction, and consultation with an endocrinologist for adrenal or calcium metabolism assessment. Hospitalization may be required in severe cases.

Healthcare professionals are encouraged to report overdose events to national poison control centers and relevant pharmacovigilance authorities. This supports post-marketing safety surveillance and risk management strategies.

Store at a controlled room temperature, typically between 15°C to 25°C (59°F to 77°F). Avoid exposure to excessive humidity, as it may compromise the stability of active ingredients and vehicle components.

Keep the tube tightly closed when not in use. Exposure to light and air can degrade calcipotriol, while heat accelerates the breakdown of betamethasone. Do not store near windows, heaters, or in vehicles during warm weather.

Unused or expired product should be disposed of following local pharmaceutical waste protocols. Avoid discarding in household trash or sinks. Accidental ingestion, particularly in children, can lead to toxicity.

When traveling, store the ointment in a cool, insulated container. Avoid packing it in checked luggage where temperature fluctuations are common. Use desiccant packets if stored in humid climates for extended periods.