How to Manage Side Effects of Treatments for Joints and Skin

How do you deal with side effects from your treatments for psoriatic arthritis (PsA) or psoriasis? Medications or natural treatments for your joint pain and swelling or skin plaques may cause side effects that you might not expect.

Biologics

Biologic drugs treat both PsA and psoriasis. They target and block specific proteins in your immune system to fight inflammation.

Biologic medications used for PsA joint symptoms could cause skin reactions like:

  • Red, itchy, or warm skin at the site where you get a shot or an IV
  • Itchy lips
  • Rarely, a full-body rash 
  • Swollen hands or ankles

It’s rare, but some biologics used to treat plaque psoriasis or PsA can lead to a condition called “lupus-like syndrome.” You might have arthritis symptoms like swollen, hard-to-move joints in your knees, hands, feet, or elbows. You may also have a rash that spreads and seems to worsen in sunlight.

What you can do: Let your nurse or doctor know right away if you have any of these symptoms. They may be signs of an allergic reaction.

If you get lupus-like syndrome from your biologic, your doctor may switch you to a different drug. Another biologic may work just as well without the side effects to your joints and skin.

Steroids

Steroids treat inflammation. You can rub topical steroids into your skin to treat psoriasis rashes. Or you might get them as a shot or take them as a pill if your PsA flares and leads to severe swelling.

Topical steroids can cause acne or red sores where you apply the cream. Over time, skin in the area could get thinner.

If you use oral steroids for too long, you could also get thinner skin or bruises. When you stop taking the meds, your psoriasis could flare and you could get a rare, severe skin disease called pustular psoriasis.

Steroid shots to treat a swollen joint from PsA may cause your skin to lose color. Or your face might flush. You could have pain where you get the shot.

What you can do: Try the lowest steroid dose you can to treat your symptoms. Use topical steroids only where you have psoriasis outbreaks. If you must take oral steroids, don’t stop taking pills all of a sudden or double up on a dose if you missed one.

Antimalarials

Some people with PsA may also take drugs created to prevent or treat malaria. One common antimalarial, hydroxychloroquine (Plaquenil), could cause a severe psoriasis flare-up, as well as a rash, dark spots on your skin, loss of hair, and even muscle weakness.

What you can do: If you notice skin or muscle side effects from your antimalarial, let your doctor know. You may need to switch drugs.

Skin Creams and Gels

For mild to moderate psoriasis, your doctor may prescribe treatments that you rub onto your skin to ease inflammation and clear up skin scales (they’ll call them topicals). Sometimes they cause skin reactions.

  • Vitamin D creams like calcipotriene (Dovonex) could irritate your skin.
  • Anthralin (Dritho-Scalp) may slough off psoriasis scales, but it can stain and irritate your skin.
  • Topical retinoids can irritate skin and make you more sensitive to sunburns.
  • Calcineurin inhibitors like pimecrolimus (Elidel) and tacrolimus (Protopic) raise your skin cancer risk. Only use them short-term.
  • Coal tar gels, creams, and scalp shampoos often irritate and stain your skin.
  • If you use them too long, salicylic acid scale softeners can cause dry, red, irritated skin or even make your psoriasis worse.

What you can do: Use any topical treatment only as directed on the package or by your doctor. Don’t use too much. If products dry your skin, switch to a more soothing cream or use a moisturizer with it.

Light Therapy

Natural or artificial light therapies may be used to treat psoriasis plaques. But some light therapy can have side effects like these:

  • Natural sunlight exposure could make your skin patches worse or even damage your skin.
  • UVB phototherapy can cause red, itchy, or dry skin, so use a moisturizer with it.
  • Burning, itchy skin is tied to short-term use of psoralen with UVA light therapy (PUVA). Used long-term, PUVA can cause dry skin, wrinkles, freckles, sun sensitivity, increased skin cancer risk, and swelling. At moderate to higher doses, PUVA could cause inflamed skin, acne, or, rarely, severe pain.
  • Excimer lasers that use UVB rays to remove skin plaques can cause red, blistered skin.

What you can do: Moisturize your skin regularly. Apply sunscreen after phototherapy. Don’t mix light therapy of any kind with any medicines that make your skin more sun-sensitive. Don’t use a commercial tanning bed for phototherapy. They’re linked to skin cancer.

Exercise

Regular exercise is good for you if you have PsA or psoriasis, because both diseases can raise your risk of heart disease or diabetes. Exercise may help you lower these risks.

Sometimes, exercise can leave your joints or muscles feeling achy and sore. If you feel any sharp pain, you may have injured yourself. If your pain lasts for a few hours, you probably just overdid it. 

What you can do: Slow down if you think you’ve done too much exercise or pushed yourself too far. Cut back on the reps and build your endurance over time. A physical therapist can help you create a safe exercise plan.

Tips to Manage Medication Side Effects

Keep these thoughts in mind when it comes to side effects of your psoriasis or psoriatic arthritis medications:

  • Every person reacts differently to each medication. You may not have any side effects at all.
  • Fear of possible side effects could boost your stress, which can trigger psoriasis flares. Try to stay calm. Don’t worry about side effects before they happen.
  • Remember that some side effects listed on package inserts are very rare.

 

WebMD Medical Reference

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