Psoriasis Treatment When You Have Other Conditions

Liver Disease and Psoriasis 

Some drugs that treat psoriasis can be hard on your liver. Methotrexate can cause scarring, but that usually goes away when you stop taking it. If you have liver disease like cirrhosis or hepatitis or if you drink heavily, you should avoid methotrexate. Acitretin is also not recommended for people with serious liver disease.

Kidney Disease and Psoriasis 

Severe psoriasis makes you more likely to have chronic kidney disease, and some of the same drugs that treat the skin disease can damage those organs. If you have severe kidney problems, you shouldn't take acitretin, cyclosporine, or methotrexate, and you should take a smaller-than-normal dose of apremilast (Otezla).

Cancer and Psoriasis 

Radiation and chemotherapy weaken your immune system. So you shouldn't take systemic psoriasis drugs if you're getting cancer treatment. People with skin cancer also should avoid light therapy, which exposes your skin to ultraviolet rays.

Psoriasis may make you more likely to have certain kinds of cancer, like lymphoma and skin cancer. Systemic drugs also appear to raise your risk of these.

Inflammatory Bowel Disease and Psoriasis 

Crohn's disease and ulcerative colitis may have a connection to psoriasis. One study found that 1 in 10 women with psoriasis also have a form of inflammatory bowel disease. Two of the biologic drugs used to treat psoriasis can cause these illnesses or make them worse. If you're affected by this, talk with your doctor before you try brodalumab (Siliq), ixekizumab (Taltz), or secukinumab (Cosentyx).

Infection and Psoriasis 

When you take a drug that slows down your immune system, like cyclosporine, methotrexate, or biologic drugs, your body can't fight off infection like it normally would. If you have an active serious infection, you shouldn't take these. You should also be tested to see if you've been exposed to tuberculosis or are carrying hepatitis B.

Many antibiotics that treat infections shouldn't be taken with systemic drugs. Some change how well your body absorbs the psoriasis drug. Others keep your kidneys from flushing the medicine from your system. That can let it build up to dangerous levels.

Pregnancy and Psoriasis 

You may find that your skin clears up when you're expecting a baby. Or it may get worse. Either way, your doctor probably will be very careful in treating your psoriasis while you're pregnant. Try over-the-counter moisturizers or petroleum jelly first. Steroid creams also appear to be safe.

But you should avoid tazarotene, a topical retinoid made from vitamin A. Retinoids in pill form are extremely dangerous if you're pregnant. Acitretin can cause serious birth defects. Because it stays in your system a while, you shouldn't try to get pregnant for at least 3 years after you take it. Methotrexate can also cause a miscarriage or birth defects. Men should wait at least 3 months and women 4 months after stopping it before they try to have a baby. Biologic drugs haven't been studied in pregnant women, so talk with your doctor about them.

You can pass some medicines to your baby through breast milk. Don't take apremilast, cyclosporine, or methotrexate while you're nursing, and don't use steroid creams on your breasts.

Light therapy that uses UVB rays is safe when you're pregnant, but the method called PUVA can cause birth defects. It combines medicine called psoralen with exposure to UVA rays. Women and men shouldn't use this if they're trying to conceive, and women who are pregnant or breastfeeding shouldn't, either.

Depression and Psoriasis 

People who have psoriasis are twice as likely to have depression as people who don't have it. Treating your psoriasis can improve your mood. But some psoriasis medications, like apremilast and brodalumab, may make depression worse.