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Systemic Treatments for Psoriasis

If you have moderate to severe psoriasis, your doctor may suggest "systemic drugs" -- medicines that affect your entire body. They're typically used when the skin condition covers more than 5% to 10% of your body and other methods haven't worked, like phototherapy and treatments you apply to your skin, such as creams, ointments, solutions, and foams.

While systemic treatment can help, many of the drugs can cause serious side effects. Your doctor will want to keep close tabs on you while you take them.

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To describe his battle against psoriasis, Alan Eisenberg likes to quote John Paul Jones, the famed Revolutionary War mariner: “I have not yet begun to fight.” For six years, the Portland, Ore., resident has been trying treatments for his skin condition. Methotrexate helped his nails, but didn’t cure the skin outbreaks. He says the prescription drug Enbrel worked for six months, then lost its effect. Another drug gave him hives. Yet another worked better, but put him at risk of infections. He had...

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Choosing a Treatment

Acitretin (Soriatane): This drug is made from vitamin A and affects the way your skin cells grow and are shed.

If you have plaque psoriasis -- inflamed, red skin with silvery scales -- it works best when you pair it with light phototherapy.

On its own, it works well to treat pustular psoriasis (a breakout of sore, red blisters or pus bumps) and erythrodermic psoriasis, where most of your skin looks intensely red and peeling, like it's burned.

This medication can cause serious birth defects even after you stop taking it. Don't take it if you’re pregnant or plan to become pregnant within 3 years of treatment.

Apremilast (Otezla): It helps fight inflammation by shutting down a certain enzyme in your immune system. Blocking this enzyme helps to slow other reactions that lead to inflammation.

This is a newer drug used just for diseases that cause long-term inflammation, like psoriasis and psoriatic arthritis. It comes in pill form.

Cyclosporine: It curbs your immune system and slows skin-cell growth. It's reserved for severe cases of psoriasis, when nothing else seems to work.

You take it by mouth. While it can help clear psoriasis, its benefits typically end when you stop taking it.

Cyclosporine also carries risks. It can cause kidney problems, high blood pressure, and high cholesterol. You shouldn't take it if you have a weak immune system or if you're breastfeeding. You should also avoid it if you're treating your psoriasis with  a form of phototherapy called PUVA.

Because of the side effects, experts suggest you not take the drug for more than a year at a time.

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