Your Health

Medications for Psoriasis

The information provided here is meant to give you a general idea of what to expect from each of these medications. Only the most common side effects are included, so ask your healthcare provider if there are any cautions specific to your case. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider.

A variety of medications are used to treat psoriasis. Generally you will start with medications that are mildest and have the fewest side effects, and then gradually move to the next level of medication, if needed.

The following prescription medications act systemically and are generally used in more severe forms of psoriasis.

Prescription Medications

Antineoplastics

  • Methotrexate

Immunosuppressive agents

  • Cyclosporine

Retinoids

  • Tazarotene—topical
  • Acitretin—oral

Topical Medications

  • Corticosteroids
  • Calcipotriene
  • Anthralin
  • Salicylic Acid

Biologic Response Modifiers

  • Etanercept
  • Infliximab
  • Alefacept
  • Ustekinumab
  • Golimumab
Antineoplastics

Common name: Methotrexate

This medication is taken on a weekly (NOT daily) basis, in either oral or injectable form. It is very helpful in reducing psoriasis symptoms. It works by interfering with certain types of skin cell growth, thus slowing the process of psoriasis cell reproduction.

Possible side effects include:

  • Nausea and vomiting
  • Diarrhea
  • Rash
  • Mild hair loss
  • Headache
  • Mouth sores
  • Reduced immune function and increased risk of infection
  • More serious problems may include:
    • Blood problems
    • Kidney problems
    • Stomach or liver problems
    • Cancer
    • Lung Inflammation

Note: Methotrexate should not be taken:

  • By women who are pregnant or nursing
  • By men who want to get their partner pregnant (methotrexate gets into sperm)
  • With alcohol
  • With non-steroidal anti-inflammatory (NSAID) pain medications
Immunosuppressive Agents

Common name: cyclosporine

Cyclosporine works by suppressing certain immune functions. Note: Do not take this medication with grapefruit or grapefruit juice, as it will increase its effect.

Possible side effects may include:

  • High blood pressure
  • Headaches
  • Joint pain
  • Body hair growth
  • Bleeding, tender, or enlarged gums
  • Reduced immune function and increased risk of infection
  • Kidney damage
  • Gout
Retinoids

Common names include:

  • Tazarotene (topical treatment)
  • Acitretin (oral treatment)

Retinoids are vitamin A related medications that may be prescribed as either topical treatments (such as gels) or oral medication. Oral retinoids are used for treating severe cases of psoriasis, while topical retinoids can be used in mild or moderate cases.

Tazarotene is used in psoriasis treatment to help reduce skin reddening and reduce the size and number of lesions. It may be prescribed alone or in conjunction with topical steroids. It is available as a gel or cream that is applied once a day and is used for skin, scalp, and nail psoriasis.

Possible side effects include:

  • Skin irritation, especially when used by itself
  • Burning or stinging of the skin (severe)
  • Changes in color of treated skin
  • Dryness, itching, peeling, or redness of the skin (severe)
  • Pain or swelling of treated skin

Contraindications:

  • Should not be used during pregnancy
  • Do not expose skin to excessive sunlight after treatment
  • Do not use around eyes, lips, or near the inside of the nose

Acitretin is used to control and relieve moderate to severe psoriasis. It works by allowing normal growth and development of skin.

Possible side effects include:

  • Elevation of triglycerides
  • Liver inflammation
  • Severe skin dryness and occasional burning sensation
  • Mild bone or joint pain
  • Headache
  • Nausea or vomiting
  • Rarely stiff, painful muscles

Contraindications:

  • Cannot be used by women who are pregnant or planning to have children in the next three years
  • Do not drink alcohol during treatment and for two months after discontinuing usage. This may both exacerbate the liver side effects of soriatane and extensively prolong the storage of the drug in the body.
  • Blood should not be donated during treatment, and 2-3 years after discontinuing usage
  • Avoid skin products containing alcohol, spices or limes, which increase sun sensitivity
  • Avoid acne products that contain peeling agents
  • Do not take vitamin A, since doses greater than the minimum daily requirement may increase your chance of developing side effects
Topical Medications

Common names include:

  • Corticosteroids
  • Calcipotriene
  • Anthralin
  • Salicylic Acid

The following topical prescription medications are generally considered step one therapies and are used as first line treatment for mild to moderate psoriasis.

Corticosteroids

Corticosteroids are used for treating inflammation of mild to moderate psoriasis. Available in many forms (such as ointments, creams, sprays, gels, shampoos and foams) and strengths, they are a synthetic version of hormones that occur naturally in the body. The weaker, over-the-counter strengths are usually not effective in treating psoriasis. Unlike systemic steroids, withdrawal (stopping) of topical steroids does not flare psoriasis.

Calcipotriene

Calcipotriene is a synthetic form of vitamin D used for treating mild to moderate psoriasis. It is a prescription medication that is available as a cream, ointment, or scalp solution. It can be used in conjunction with other treatments, but should be used in limited amounts to avoid side effects such as local irritation, rash, or worsening of psoriasis. Calcipotriene has recently become available in combination with a topical steroid Betamethasone.

Anthralin

Anthralin can be very effective for treating mild to moderate psoriasis, particularly the tough-to-treat thick patches. It is often used in conjunction with ultraviolet light treatments. This treatment has no known long-term side effects, but may irritate skin and stain clothes. Anthralin is rarely used in modern psoriasis treatment regimens.

Salicylic Acid

This medication is used to soften and remove scale from psoriasis plaques. When scales are removed, other medications may penetrate the skin and promote healing. Salicylic acid is available in many strengths and types of preparations. Milder strengths are available without prescription.

Biologic Response Modifiers

Common names include:

  • Etanercept
  • Infliximab
  • Alefacept
  • Ustekinumab
  • Adalimumab
  • Golimumab

These medications are prescribed when conventional medications have failed. They are taken as an IV infusion or as an injection. They work by blocking the action of TNF, a pro-inflammatory cytokine implicated in the development of psoriasis, or by inhibiting inflammatory cell activation in the skin. All patients receiving these medications must first undergo a skin test for tuberculosis , a chest x-ray , a complete blood count , as well as blood tests for liver and kidney function. Certain blood tests will continue to be monitored throughout the course of treatment.

Possible side effects include:

  • Chills
  • Headache
  • Fever
  • Nausea
  • Muscular pain or tenderness
  • Injection site reactions

Serious complications may include:

  • Allergic reactions
  • Serious infections
  • Blood-related cancers
  • Low platelets
  • Severe, immune-mediated anemia
  • Arthritis events
  • Psoriasis worsening
  • Lupus-like reactions
  • Multiple sclerosis-like reactions
  • Increased risk for children and teens to develop Hodgkin’s and non-Hodgkin’s lymphoma and other types of cancer

Contraindications:

  • Known chronic infections
  • Allergy to any of the medication components
  • Low white blood cell counts

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Do not share them with anyone else.
  • Know what effects and side effects to expect, and report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you do not run out.

When to Contact Your Doctor

Contact your doctor if you have any adverse reactions to new or existing medication treatments, or if you feel that a new medication is not working. Also, call anytime you have questions about using your medicine.

Revision Information

  • American Academy of Dermatology web site. Available at: http://www.skincarephysicians.com/ .

  • Lam J, Polifka JE, Dohil MA. Safety of dermatologic drugs used in pregnant patients with psoriasis and other inflammatory skin diseases. J Am Acad Dermatol . 2008 Apr 12.

  • National Psoriasis Foundation web site. Available at: http://www.psoriasis.org/home/ .

  • National Library of Medicine website. Available at: http://www.nlm.nih.gov/ .

  • Psoriasis drug Raptiva pulled from US market. Health Day News, EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Published April 9, 2009. Accessed July 29, 2008.

  • Ting PT, Koo JY. Use of etanercept in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients. Int J Dermatol . 2006;45:689-692.

  • Ustekinumab. EBSCO Health Library, Lexi-Pals website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated August 2008. Accessed October 2, 2009.

  • 10/2/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : FDA approves new drug to treat psoriasis. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183851.htm . Published September 25, 2009. Accessed October 2, 2009.

  • 10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Menter A, Gordon KB, Leonardi CL, Gu Y, Goldblum OM. Efficacy and safety of adalimumab across subgroups of patients with moderate to severe psoriasis. J Am Acad Dermatol . 2010;63(3):448-456.