a) use an ointment.

a) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

b) use a cream.

b) True _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

c) tell the patient not to use it on the face, folds or genitalia.

c) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

d) tell the patient to use it for a few weeks, then stop for a week or two to avoid side effects.

d) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

a) combining both treatments will produce better results and longer duration of improvement.

a) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

b) calcipotriol does not cause atrophy, telangiectasia, striae, and other steroidal side effects.

b) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

c) calcipotriol does not induce tachyphylaxis.

c) True _ _ _ _ _ _ _ _ _ _ Correct. Anything else? ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯

Answer and Commentary _ _ _ _ _ _ _ _ _ _ (Part I) a, c and d. For dry skin disease, ointments can be used to provide better hydration and better penetration of the agent. However, their absorption is significantly increased on the face, genitalia and folds, and mid-potency steroids should be avoided on these areas because of potential side effects such as atrophy, telangiectasia, striae and systemic absorption. (Part II) All of the above. Topical calcipotriol is a vitamin D3 analog which can be used alone as monotherapy or in combination with other modalities for the treatment of psoriasis. The addition of topical calcipotriol can help reduce the amount of steroid required as well as help reduce the number of visits needed for phototherapy.¹ Calcipotriol does not cause side effects normally associated with topical corticosteriods, but if used extensively it is associated with a risk of hypercalcemia. The maximum recommended weekly dose for this drug is 100 g/week. Calcipotriol has the potential to irritate sensitive skin and should be avoided on the face, folds and genitalia. In combining calcipotriol with topical steroid therapy, one preparation should be applied in the morning and the second in the evening. (Stability data is not available for an extemporaneous compound.) -------------------- ¹ Anne Frappez, Jean Thivolet, Calcipotriol in combination with PUVA: a randomized double blind placebo study in severe psoriasis, European Journal of Dermatology, 1993; 3: 351-4. ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯