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Pustular Psoriasis (cont.)

Medications for Pustular Psoriasis

The goals of medications are to reduce symptoms and prevent complications. In general, topical treatment is of limited use in treating extensive pustular psoriasis. Options to be considered for limited disease include bland emollients and topical steroids, substances unlikely to produce any local irritation or inflammation. 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

  • Corticosteroids: Clobetasol (Temovate), fluocinolone (Synalar), and betamethasone (Diprolene) are some of the commonly prescribed corticosteroids. These creams or ointments are usually applied twice a day, but the dose depends on the severity of the psoriasis.

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 blocks the chemical messengers of inflammation. It is FDA approved for psoriasis and 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 not used in persons with significant heart failure or active infections.
  • 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.
Medically Reviewed by a Doctor on 5/8/2014

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