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Systemic Treatment 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 psoriasis covers more than 5% to 10% of your body and you haven't seen improvement from other methods, 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 monitor you closely.

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Choosing a Systemic Treatment

Apremilast (Otezla). Apremilast helps fight inflammation by shutting down an enzyme in the immune system. The specific enzyme is called PDE-4. Blocking PDE-4 helps to slow other reactions that lead to inflammation. 

This is a new kind of drug which is used specifically for long-term inflammation diseases. Because it is a relatively new treatment, doctors don't know yet if it prevents or stops joint damage when used to treat psoriatic arthritis. Apremilast comes in pill form.

Cyclosporine. Like methotrexate, this drug curbs your immune system and slows the growth of your skin cells. It's typically used only in severe cases of psoriasis, when nothing else seems to work.

You take cyclosporine by mouth. While it can help clear psoriasis, its benefits typically last only for as long as you're using it.

Cyclosporine also carries risks. It can cause kidney problems, high blood pressure, and high cholesterol. If you have a weak immune system or you're breastfeeding, you shouldn't take it. You also shouldn't use it if you're treating your psoriasis with PUVA therapy, a form of phototherapy. Because of the potential side effects, experts recommend that you not take the drug for more than a year at a time.

Hydrea (hydroxyurea). This drug has fewer side effects than some of the stronger systemic medications, but it's also less effective.

Hydrea's side effects include bone marrow problems and an increased risk of skin cancer. Don't take it if you're pregnant or might become pregnant.

While it's been used as a treatment for psoriasis for years, the FDA has not specifically approved it for this use.

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