Dovonex

Dovonex is a topical treatment for mild to moderate plaque psoriasis containing calcipotriol, a synthetic analogue of the active form of vitamin D (calcitriol). Unlike topical corticosteroids, Dovonex does not contain any steroid component and therefore does not carry the risks associated with long-term corticosteroid use, such as skin thinning or adrenal suppression. This makes it a particularly valuable option for patients who require longer-term management of psoriasis or who need to treat areas that are sensitive to corticosteroid effects.

How Calcipotriol Works

Calcipotriol works by binding to vitamin D receptors (VDRs) on keratinocytes, the predominant cell type in the outer layer of the skin. In psoriasis, keratinocytes divide and mature at an abnormally rapid rate, producing the characteristic thickened, scaly plaques. Calcipotriol normalises this proliferation by reducing the rate of cell division and promoting more normal differentiation and maturation of keratinocytes. It also has moderate immunomodulatory effects, reducing the activity of T-lymphocytes and dendritic cells within psoriatic plaques and thereby dampening the immune-mediated inflammation that drives the condition.

Importantly, the structural modifications made to calcipotriol compared with calcitriol (natural vitamin D) mean that it has a much lower tendency to affect systemic calcium metabolism. This means that, when used within recommended dose limits, it does not cause the hypercalcaemia that would result from comparable amounts of natural vitamin D.

Forms Available and Clinical Use

Dovonex is available as a cream, ointment, and scalp solution. The cream is suitable for most body areas and is the most commonly prescribed formulation. The ointment provides greater moisturising effects and is preferred for dry, thick plaques. The scalp solution is designed for easy application to the scalp without disturbing the hair. Dovonex is used twice daily for most indications and is appropriate for long-term management of psoriasis, either as sole therapy or as part of a rotational treatment strategy alongside other agents.

How to Apply Dovonex

Apply Dovonex (calcipotriol) cream or ointment to the affected psoriatic plaques twice daily (morning and evening). Apply a thin layer and rub in gently. Apply only to the plaques themselves — avoid applying to the surrounding normal skin, as it can cause irritation. Wash your hands thoroughly after each application unless the hands are the treatment area.

Dovonex is not suitable for use on the face or in skin folds, as these areas are much more sensitive and prone to irritation. Your doctor may prescribe a different preparation for facial or flexural psoriasis.

Weekly Dose Limit

Do not exceed 100 g of Dovonex cream or ointment per week (equivalent to about two 50 g tubes). Exceeding this amount risks raising blood calcium levels. Continue treatment as long as it is effective and your doctor advises — unlike corticosteroids, Dovonex does not cause skin thinning.

Dovonex cream and ointment are applied twice daily. The maximum recommended dose is 100g per week for adults. This limit is important as exceeding it may lead to elevated serum calcium levels (hypercalcaemia). If treating both the body and the scalp simultaneously, the combined amount should not exceed the weekly maximum. For the scalp solution, the maximum weekly volume should be observed as directed in the product information.

No dose adjustment is required for elderly patients on the basis of age alone, but the minimum effective amount should be used. Dovonex is not licensed for children under 6 years; for children aged 6 to 12, the maximum dose is 50g per week; for those aged 12 to 18, the maximum is 75g per week. Children should only use Dovonex under medical supervision. Long-term use within the recommended dose limits is considered safe, but serum calcium should be monitored periodically if large areas are being treated or if there is any concern about calcium metabolism.

Common Side Effects

• Local skin irritation, burning, or stinging (particularly in the first few weeks — often settles as the skin adjusts)
• Itching at the application site
• Skin dryness or peeling
• Redness at the treated area
• Skin irritation on the surrounding normal skin
• Temporary worsening of psoriasis at the start of treatment

Calcium Effects

Calcipotriol is a vitamin D analogue and can raise blood calcium levels if used in excessive amounts. This is only a concern if the weekly dose limit is exceeded. Symptoms of raised calcium include increased thirst, frequent urination, nausea, and confusion. Stay within the recommended weekly dose of 100 g and this risk is negligible.

Dose Limits and Calcium Monitoring

The most important safety consideration with Dovonex is adherence to the recommended weekly dose limit. Calcipotriol can increase calcium absorption and, if used in excess, may cause hypercalcaemia -- elevated blood calcium levels that can have serious effects on the heart, kidneys, and nervous system. Patients using large amounts of Dovonex, or those treating large areas of their body, should have their serum calcium checked periodically.

Dovonex should not be used in patients with known disorders of calcium or phosphate metabolism, including primary hyperparathyroidism, sarcoidosis, vitamin D toxicity, or hypercalcaemia from any cause. Patients with severe renal or hepatic impairment should use Dovonex with caution, as these conditions may affect calcium and vitamin D metabolism.

Application Site Warnings

Dovonex should not be applied to the face, skin folds, or the genitalia, as these areas are particularly susceptible to irritation. Calcipotriol is a potent irritant to the face and can cause severe facial dermatitis even when applied to other body parts if hands are not washed thoroughly after application. Patients should be reminded to always wash their hands carefully after applying Dovonex and to avoid touching the face afterwards. The scalp solution should be kept away from the eyes. Unlike topical corticosteroids, Dovonex does not cause skin thinning and is therefore safe for longer-term use within dose limits.

• Hypersensitivity to calcipotriol or any excipient in the formulation
• Disorders of calcium metabolism (hypercalcaemia, hypercalciuria, primary hyperparathyroidism)
• Severe renal impairment (risk of impaired calcium regulation)
• Severe hepatic impairment
• Erythrodermic or pustular psoriasis
• Application to the face or skin folds
• Children under 6 years of age
• Sarcoidosis or other granulomatous diseases (risk of hypercalcaemia)
• Vitamin D toxicity