Dovonex
What is Dovonex and how does it work?
Dovonex (also known by its generic name calcipotriene) is a form of synthetic vitamin D3 approved by the FDA for treating psoriasis. It slows down the rate of skin cell growth, flattens psoriasis lesions and removes scale. It is not effective at decreasing inflammation, though for most patients redness will improve over time.
Dovonex is sold as a cream, ointment and scalp solution. All Dovonex products come in 0.005% strength, and they are odorless and nonstaining.
Dovonex is not related to vitamin D found in vitamin supplements taken by mouth. These supplements should not be used to treat psoriasis. Ingesting large doses of vitamin D–even though it is sold without a prescription–can cause serious side effects.
How well does Dovonex work?
Patients using Dovonex often see results after two weeks of treatment, but clearance or full effect usually takes at least eight weeks. Doctors typically prescribe Dovonex for an initial treatment period of six to eight weeks.
In general, Dovonex does not work as quickly as superpotent topical steroids, but unlike steroids, Dovonex has no known serious side effects when used according to directions. Dovonex is FDA-approved for long-term use.
For psoriasis plaques on the body, studies have shown that Dovonex ointment is slightly more effective than the cream.
How is Dovonex used?
Dovonex should be applied directly to psoriasis lesions in a thin layer. It is important to follow your doctor's directions in applying Dovonex. Dovonex can irritate unaffected skin. Patients should always wash their hands thoroughly after applying the medication to avoid spreading it to unaffected areas of skin.
Covering or wrapping (occlusion) of Dovonex-treated skin can result in rapid clearance but should only be done under a doctor's guidance. Doctors usually recommend applying Dovonex twice per day.
A ring of scaling around Dovonex-treated psoriasis plaques leads some people to worry that their psoriasis is spreading. In fact, it may be a sign that the psoriasis is about to clear.
Using Dovonex on the scalp
Dovonex scalp solution is a water- and alcohol-based formulation specifically designed for treating scalp psoriasis.
Rub the solution gently into scalp lesions at night, and then cover (occlude) the scalp with a shower cap or plastic bag overnight. The Dovonex may be washed out in the morning.
Avoid getting the mixture on the face or around the eyes, where it can cause irritation. Sweat can carry the medication onto the face and neck as well, so it is important to protect unaffected areas of skin. Also, Dovonex scalp solution should not be used during a flare of scalp lesions; the alcohol in the solution may irritate the skin.
Using Dovonex for nail psoriasis
Dovonex has proven successful in treating nail psoriasis for some patients. In one study, Dovonex ointment proved about as effective for nail psoriasis as a combination ointment of salicylic acid and a topical steroid.
Side effects of using Dovonex
Dovonex has no known serious side effects when used according to guidelines. The most common minor side effect is skin irritation, usually in the form of stinging or burning. This adverse reaction to Dovonex is generally mild, and the irritation should decrease as the skin becomes accustomed to the medication. Some dermatologists recommend mixing Dovonex with petroleum jelly, first at a ratio of 1-to-1 and then in increasing amounts of Dovonex to help the skin adjust.
Less common side effects for Dovonex include dry skin, peeling, rash, dermatitis and worsening of psoriasis.
The face, the genitals and skin folds can be extremely sensitive to Dovonex irritation. Wash hands thoroughly after applying Dovonex to prevent transferring the medication to sensitive areas.
Do not overuse Dovonex, as the medication can be absorbed into the body, increasing the risk of side effects. Guidelines recommend using no more than 100 grams of Dovonex cream or ointment, or 60 milliliters of the scalp solution in one week.
Dovonex is not recommended for use during pregnancy unless the benefits outweigh the possible risks to the fetus. It should not be used during breast-feeding, as the medication may be passed through breast milk.
Using Dovonex with other treatments
Because Dovonex is relatively safe and free of serious side effects, it is used in combination with many other treatments.
Combining Dovonex with topical steroids—for example, applying one at night and the other in the morning—can be more effective and less irritating than using Dovonex alone. Also, according to one study, a combined maintenance treatment of daily Dovonex plus weekend use of a superpotent topical steroid (called pulse therapy) may prolong remissions.
If Dovonex is prescribed along with other topicals, apply the medications at different times of day and never mix them. The active ingredient in Dovonex is easily inactivated, particularly by acidic compounds like salicylic acid.
Dovonex increases the effectiveness of UVB treatments and PUVA treatments. Dovonex should be applied only after UV treatment because it may partially block the light during treatment, and UV rays can inactivate the medication.
In moderate to severe cases of psoriasis, Dovonex and several systemic treatments may be combined. With cyclosporine or Soriatane (also known by its generic name acitretin), Dovonex improves overall results and reduces the amount of systemic drugs needed, thereby reducing their risks and side effects. There are no known problems using Dovonex with methotrexate or biologics, but studies are limited.
Updated June 2006
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