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Medications for Moderate to Severe Psoriasis continued...

1. Cyclosporine

What it is: Cyclosporine ( Neoral) is a drug that has been used to prevent organ rejection in transplant patients. It is also approved for treating psoriasis.

How it works: It suppresses the immune system and slows the growth of certain immune cells. Cyclosporine is given by capsule or liquid.

Side effects can include flu-like symptoms, headache, high blood pressure, higher cholesterol, sensitive skin, tingling in the arms or legs, upset stomach, fatigue, kidney damage, excess hair growth, kidney damage, and an increased risk for cancer.

2. Methotrexate

What it is: A drug that was first used to treat cancer.

How it works: Methotrexate slows the rate of skin cell growth. Methotrexate can be given by pill, liquid, or injection.

Side effects can include nausea, vomiting, fatigue, headache, lightheadedness, easy bruising and bleeding, fever, trouble sleeping, sensitivity to sunlight, hair loss, and liver damage.

Pregnant women are at risk of having a baby with birth defects while taking this drug.

3. Biologic Treatments

What it is: Biologic drugs target the immune response that causes inflammation.

How it works: Biologics block immune cells that are involved in psoriasis. These drugs are given by a shot or by an IV infusion.

Biologic drugs include:

  1. Ustekinumab (Stelara). This drug blocks cytokines in the body called interleukin-12 and interleukin-23, which are thought to promote the increased growth rate of skin cells and inflammation from psoriasis.
  2. Secukinumab ( Cosentyx). This is an antibody that binds to interkeukin-17A which is also involved in inflammation.
  3. Tumor necrosis factor-alpha blockers, including adalimumab ( Humira), etanercept ( Enbrel), and infliximab ( Remicade). These drugs block a chemical messenger of the immune system called TNF-alpha. People with psoriasis have too much of this substance, which causes inflammation.

Side effects can include swelling or rash at the injection site, increased risk for infections, including tuberculosis, and cancers such as lymphoma and nonmelanoma skin cancer.

You may need to be screened for tuberculosis while taking a biologic drug. You may also need to have regular blood tests to check your number of immune blood cells.

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