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 3% 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.

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.

Continued

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

It can cause bone-marrow problems and a higher risk of skin cancer. Don't take it if you're pregnant or might become pregnant.

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

Methotrexate: This drug eases symptoms by curbing your immune system and slowing the rapid growth of skin cells.

You take it once a week either by mouth or in a shot. You should see results after 4 to 6 weeks.

This drug can have serious side effects. At first, you might have nausea or fatigue. Over time, it can damage your liver and blood cells.

Tell your doctor about any other health issues you have. Methotrexate isn’t safe for people with anemia or liver disease. You should also limit how much alcohol you drink. Even one glass a day while you're on it can cause liver problems. You'll need regular blood tests so your doctor can check on your blood cells and liver.

A daily oral folate supplement should be taken when you are using this medication.

Men and women both should stop taking it when planning a pregnancy.

Biologics: They target proteins in your immune system that play a role in the inflammation process. They have fewer side effects than traditional systemic therapy.

Biologics include:

They’re used for moderate to severe cases of psoriasis that don’t respond to other treatments. They can also help with psoriatic arthritis, a long-term condition that comes along with psoriasis and causes painful, swollen joints.

They also help decrease the risk for cardiovascular events such as heart attacks and stroke, which are more likely in psoriasis patients as compared to patients without psoriasis.

Other drugs: A number of medications used for cancer, preventing transplant rejection, and other conditions are also used to treat psoriasis. They include:

While these drugs haven't been approved by the FDA for psoriasis treatment, they may help.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on July 20, 2016

Sources

SOURCES:

 

Abel, E. " Psoriasis," ACP Medicine, BC Decker, 2005.

American Academy of Dermatology.

American College of Rheumatology: "Psoriatic Arthritis."

FDA. "FDA approves new psoriasis drug Taltz."

Jeffrey M. Weinberg, MD, Mount Sinai St. Luke's, New York; associate clinical professor of dermatology, Columbia University College of Physicians and Surgeons; consultant to Amgen and Genentech.

National Institute of Arthritis and Musculoskeletal and Skin Diseases.

National Psoriasis Foundation.

Strober, Bruce E., MD, PhD, associate professor, vice chair, director of clinical trials, Department of Dermatology, University of Connecticut; consultant to NexGenix Pharmaceuticals Holdings, Amgen, Biogen, Genentech, Fujisawa, and 3-M.

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