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Pustular Psoriasis (cont.)

Medications for Pustular Psoriasis

The goals of medications are to reduce symptoms and prevent complications.

Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitamin D-3 derivatives, coal tar, anthralin, or retinoids. Generic drug names are listed below with examples of brands in parentheses.

Topical medications

  • Vitamin D: Calcipotriene (Dovonex) is a form of vitamin D-3 and slows the production of excess skin cells. It is used in the treatment of moderate psoriasis. This cream, ointment, or solution is applied to the skin two times a day.
  • Coal tar: Coal tar (DHS Tar, Doak Tar, Theraplex T) contains literally thousands of different substances that are extracted from the coal carbonization process. Coal tar is applied topically and is available as shampoo, bath oil, ointment, cream, gel, lotion, ointment, paste, and other types of preparations. The tar decreases itching and slows the production of excess skin cells.
  • Corticosteroids: Clobetasol (Temovate), fluocinolone (Synalar), and betamethasone (Diprolene) are commonly prescribed corticosteroids. These creams or ointments are usually applied twice a day, but the dose depends on the severity of the psoriasis.
  • Tree bark extract: Anthralin (Dithranol, Anthra-Derm, Drithocreme) is considered to be one of the most effective antipsoriatic agents available. It does have potential to cause skin irritation and staining of clothing and skin. Apply the cream, ointment, or paste sparingly to the patches on the skin. On the scalp, rub into affected areas. Avoid the forehead, eyes, and any skin that does not have patches. Do not apply excessive quantities.
  • Topical retinoid: Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. Tazarotene reduces the size of the patches and the redness of the skin. This medicine is sometimes combined with corticosteroids to decrease skin irritation and to increase effectiveness. Tazarotene is particularly useful for psoriasis of the scalp. Apply a thin film to the affected skin every day or as instructed. Dry skin before using this medicine. Irritation may occur when applied to damp skin. Wash hands after application. Do not cover with a bandage.

Systemic medications (those that circulate throughout the body)

  • Acitretin (Soriatane) or isotretinoin (Accutane, Amnesteem, Claravis, Sotret) are both vitamin A-like drugs available orally. These drugs are generally used immediately to control the acute pustular eruption and then followed by more long-term medications and therapies as noted below.
  • Methotrexate (Rheumatrex): This drug 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. Men must not take this drug if there is a possibility that they will impregnate their partners because it can go into the sperm. 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.
  • Etanercept (Enbrel): This drug is a manmade protein that works with the immune system to reduce inflammation. It is FDA approved for psoriatic arthritis. Etanercept is given as an injection two times per week. The drug can be injected at home. Rotate the site of injection (thigh, upper arm, abdomen). Do not inject into bruised, hard, or tender skin. Enbrel affects your immune system and is rarely associated with heart failure.
  • Adalimumab (Humira): An antibody that binds to TNF, a key mediator of inflammation. Adalimumab is injected every two weeks and is not used in persons with significant heart failure or active infections.
  • 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 high blood pressure.
  • Alefacept (Amevive): In 2003, the FDA approved this drug for the treatment of psoriasis. It suppresses the immune system to slow down the production of skin cells. Alefacept is given as an injection once per week. Women who become pregnant while taking alefacept should be enrolled in the manufacturer's pregnancy registry by calling 866-263-8483. Alefacept may increase the risk of malignancy or infection, may cause allergy or swelling of the throat or tongue, and may cause a hard lump, inflammation, or bleeding at the injection site.
  • Ultraviolet light therapy

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