Systemic Medications for Psoriasis
Systemic medications (those taken by mouth or injection)
- Psoralens: Methoxsalen (Oxsoralen-Ultra) and trioxsalen (Trisoralen) are commonly prescribed drugs called psoralens. Psoralens make the skin more sensitive to light. These drugs have no effect unless carefully combined with ultraviolet light therapy. This therapy, called PUVA, uses a psoralen drug with ultraviolet A (UV-A) light to treat psoriasis. This treatment is used when psoriasis is severe or when it covers a large area of the skin. Psoralens are taken by mouth several hours before PUVA therapy or sunlight exposure. They are also available as creams, lotions, or in bath soaks. More than 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy is usually given two to three times per week on an outpatient basis, with maintenance treatments every two to four weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. These drugs cause sensitivity to sunlight, risk of sunburn, skin cancer, and cataracts.
- Etanercept (Enbrel): This is the first drug that the FDA approved for treating psoriatic arthritis. It is a manufactured protein that works with the immune system to reduce inflammation. Etanercept is given as an injection two times per week. The drug can be injected at home. Enbrel affects your immune system and rarely is associated with heart failure.
- Methotrexate (Rheumatrex): This drug is used to treat plaque psoriasis or psoriatic arthritis. It suppresses the immune system and slows the production of skin cells. Methotrexate is taken by mouth (tablet) or as an injection once per week. Women who are planning to become pregnant or who are pregnant should not take this drug. The doctor will order blood tests to check your blood cell count and liver and kidney function on a regular basis while on this medicine.
- Cyclosporine (Sandimmune, Neoral): This drug suppresses the immune system and slows the production of skin cells. Cyclosporine is taken by mouth once a day. Your doctor will order tests to check your kidney and liver function and levels of cyclosporine in your blood while you are on this medicine. Cyclosporine may increase the risk of infection or lymphoma, and it may cause damage to the kidneys, producing high blood pressure.
- Acitretin (Soriatane): This drug is an oral retinoid or a modified vitamin A molecule. It does not appear to be as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis. However, it works for pustular psoriasis. In women of childbearing age, acitretin must be used with caution because of the risks of birth defects. Furthermore, because of the long time needed for the elimination of acitretin from the body, even after treatment is stopped, women must continue to avoid pregnancy for three years. Regular blood tests are required while taking this medication. Side effects include dryness and irritation of the skin, lips, eyes, nose, and mucous membrane surfaces. Other adverse side effects include thinning hair, elevation of the cholesterol and triglyceride levels, liver toxicity, and bone changes. Do not donate blood while taking Soriatane and for two years after stopping it.
- Adalimumab (Humira): Humira is used to treat moderate to severe chronic plaque psoriasis in adults. It is a protein that blocks TNF-α, a type of chemical messenger in the immune system. In psoriasis, TNF-α overstimulates immune system cells (T cells) and causes psoriatic lesions to develop. Humira is taken by injection under the skin and is available by prescription only. The recommended dose for adults is one injection every two weeks. Side effects include severe infection, reactivation of TB or hepatitis B, allergic reactions, serious blood disorders, lymphoma, and other cancers.
- Ustekinumab (Stelara): This drug blocks two proteins called interleukin-12 and interleukin-23, which are parts of the immune system. Interleukins-12 and 23 promote the inflammation associated with psoriasis. Stelara is injected under the skin at weeks 0, 4, and every 12 weeks thereafter. Ustekinumab may potentially increase the risk of malignancy or infection; it also may cause allergic reactions, including skin rash, facial swelling, and difficulty with breathing.
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