Pustular Psoriasis (cont.)
What Medications Treat 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.
- 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 one's blood cell count and liver and kidney function on a regular basis while on this medicine.
- Cyclosporine (Sandimmune, Neoral): This orally administered drug suppresses the immune system. A doctor will order blood tests to check kidney and liver function and levels of cyclosporine to monitor for toxicity. Cyclosporine may increase the risk of infection or lymphoma, and it may cause high blood pressure.
- Infliximab (Remicade, Inflectra) is a biologic drug that has been used to treat pustular psoriasis. It must be administered by intravenous infusion.
- Etanercept (Enbrel): This drug is a manmade protein that blocks the TNF, inhibiting 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. Enbrel affects the immune system and is not used in people with significant heart failure or active infections.
- Adalimumab (Humira) is an antibody that binds to TNF, a key mediator of inflammation. Adalimumab is injected every two weeks and is not used in people with significant heart failure or active infections.
- Ustekinumab (Stelara): This injectable protein drug interferes with the inflammatory cascade by blocking chemical messengers of inflammation to treat pustular psoriasis.
Medically Reviewed by a Doctor on 9/11/2017
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