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.
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, as if 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 an 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.
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 chance 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.
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.
Researchers are always testing new medicines. The biologics now available to treat plaque psoriasis and psoriatic arthritis are:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Infliximab (Remicade)
- Secukinumab (Cosentyx)
- Ustekinumab (Stelara)
Biologics that are approved for plaque psoriasis are:
- Brodalumab (Siliq)
- Ixekizumab (Taltz)
If you have psoriatic arthritis, the FDA-approved biologics that your doctor may suggest are:
- Golimumab (Simponi)
- Certolizumab (Cimzia)
Drugs that curb your immune system: A number of these kinds of medications are sometimes suggested by doctors to treat psoriasis, even though they haven't been approved by the FDA for that purpose. Some examples are:
These drugs are sometimes used if other systemic treatments don't work or you can't take them. Your doctor will talk to you about all your treatment options.