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Other Medications for Psoriasis

Reviewed by Brunilda Nazario, MD on October 07, 2020

If you have moderate to severe psoriasis, your doctor may suggest a systemic drug -- medicine that affects your whole body. They're typically used when the skin condition covers more than 5% to 10% of your body and other treatments haven't worked.

While systemic treatment can help, many can cause serious side effects. Your doctor will want to keep a close eye on you while you take the medicine.

Types of Systemic Drugs

Retinoids. These are made from vitamin A and affect the way your skin cells grow and are shed. Most doctors prescribe one called acitretin (Soriatane).

If you have plaque psoriasis -- inflamed, red skin with silvery scales -- a retinoid works best when used with phototherapy. On its own, it works well to treat pustular psoriasis -- a breakout of sore, red blisters or pus bumps -- and erythrodermic psoriasis in which most of your skin looks very red and peels 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 get pregnant within 3 years.

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

You take it once a week either by mouth or in a shot, and you should notice changes after 4 to 6 weeks. But this drug can have serious side effects. At first, you might have nausea or fatigue, and 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 who have anemia or liver disease. You should also watch 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. You’ll need to take it with daily folic acid to reduce side effects.

Both men and women should stop taking it if they plan to start a family.

Cyclosporine. This drug lowers your immune system. It also slows skin cell growth. It's used only for severe cases of psoriasis when nothing else seems to work. You take it by mouth.

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While it can help clear psoriasis, cyclosporine’s benefits typically end when you stop taking it. It also can lead to 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 don’t recommend taking the drug for more than a year at a time.

Apremilast (Otezla). This is a newer drug used just for diseases that cause long-term inflammation, like psoriasis and psoriatic arthritis. It shuts down an enzyme in your immune system, and that slows other reactions that lead to inflammation. It comes in pill form.

Biologics. If your psoriasis is severe or other treatments haven’t worked well enough for you, your doctor might recommend one of these drugs. They affect specific parts of your immune system that play a role in psoriasis.These include:

  • Adalimumab (Humira)
  • Brodalumab (Siliq)
  • Ccertolizumab (Cimzia)
  • Etanercept (Enbrel)
  • Guselkumab (Tremfya)
  • Infliximab (Remicade)
  • Ixekizumab (Taltz)
  • Risankizumab (Skyrizi)
  • Secukinumab (Cosentyx)
  • Tildrakizumab (Ilumya)
  • Ustekinumab (Stelara)
How Biologics Work for Severe PsoriasisWhat do biologics do inside your body to help soothe your psoriasis? See what happens when they go to work.68

[MUSIC PLAYING]

SPEAKER: Psoriasis appears

on the outside of your skin,

but it really begins

inside your body.

It happens when

your immune system starts

attacking healthy skin cells

by mistake.

What triggers this attack though

is a mystery.



As your blood cells widen,

your skin becomes warm and red.

At the same time, your body

starts making more and more skin

cells at a faster rate

than normal.

This causes thick, red, scaly

patches to form on your skin.



If your psoriasis is severe

and isn't responding

to treatment, a biologic may be

able to help.

Biologics are

protein-based drugs that come

from living sources.

They target

the specific proteins and cells

of your immune system

that are causing

the inflammation in your skin.

By attaching to its target

protein or cell, the biologic

blocks it from interacting

with other cells.

In this way, it helps stop

the cycle of inflammation that's

causing your psoriasis

and other medical problems.

National Psoriasis Foundation: “Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs.”<br> National Psoriasis Foundation: “The Making of Biologics.”<br> International Journal of Molecular Sciences: "Old and New Biological Therapies for Psoriasis.<br> F1000 Medicine Reports: "The role of TNF inhibitors in psoriasis therapy: new implications for associated comorbidities."/delivery/aws/dc/a3/dca3eb54-d493-3f22-9ab7-50fa770ae9b3/091e9c5e81dcfc6c_funded-medical-animation-psoriasis-how-biologics-work_,4500k,2500k,1000k,750k,400k,.mp412/10/2019 14:37:0018001200photo illustration of biologics/webmd/consumer_assets/site_images/article_thumbnails/video/1800x1200_funded_medical_animation_psoriasis_how_biologics_work_video.jpg091e9c5e81dcfc6c

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Biosimilars. These medicines are patterned after biologics. They also work the same way in your body. Examples include:

  • Adalimumab-adbm (Cyltezo)
  • Adalimumab-atto (Amjevita)
  • Etanercept-szzs (Erelzi)
  • Infliximab-dyyb (Inflectra)
  • Infliximab-abda (Renflexis)

Because your immune system may not work as well as it should while you take these drugs, you may be more likely to get infections or certain diseases. So your doctor may not prescribe them if your immune system is already weak because of a health condition or other medication you take. Read more about advanced treatments for psoriasis.

Preparing for Bath Time With Psoriasis A warm bath may be the answer to flaky, irritated skin caused by psoriasis.72

[MUSIC PLAYING]

SPEAKER: If your skin is itchy

and irritated from psoriasis,

sometimes a bath can help.

Soaking in a warm bath

can be soothing for your skin.

Just make sure the water isn't

too hot because hot water can

make the skin irritation

and dryness worse.

And be careful scrubbing.

Too much can cause a flare up.



Hop in the shower for 10 minutes

or soak in the tub every day.



There are a few things you can

add to your warm bath water

to help with the redness

and flaky skin.

An oatmeal bath

may be comforting

and can help to loosen scales.

You can either buy

an over-the-counter product

or blend 1 cup of oatmeal

into a fine powder

and add it to your bath water.



Epsom salts and Dead Sea salts

can also help remove scales

and decrease itching.

Add them to your warm bath

and soak in the tub for up to 15

minutes.



Don't forget to apply

moisturizers when you get out

of the tub.

Pat your skin dry so you're not

dripping wet, and apply lotion

right away.

You might even find

that cool lotion is more

soothing.

So try keeping your moisturizers

in the fridge.

A warm bath with oats or salts

and cool lotion may be just what

you need to soothe

your itchy skin.

National Psoriasis Foundation: "Managing Itch," "Herbal and Natural Remedies."<br> University of Maryland Medical Center: "Psoriasis."/delivery/e3/ab/e3ab1cd6-bd0c-4842-845b-6383cdb76ae4/vd-1384-ah-bath-time-with-psoriasis_,2500k,400k,1000k,750k,4500k,.mp401/18/2018 12:56:00650350running a bath/webmd/consumer_assets/site_images/article_thumbnails/video/bath_time_with_psoriasis_video/650x350_bath_time_with_psoriasis_video.jpg091e9c5e815dfc79
WebMD Medical Reference

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," “FDA approves Inflectra, a biosimilar to Remicade,” “FDA approves Amjevita, a biosimilar to Humira.”

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.

Medscape: "FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis."

National Institute of Arthritis and Musculoskeletal and Skin Diseases.

National Psoriasis Foundation.

 

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