Psoriasis Treatment: Medicine that Works throughout the Body
when faulty signals in the immune system cause new skin cells to
form in days rather than weeks. Because this occurs inside the body,
medicine that works inside the body is often needed to treat
moderate to severe psoriasis. Your dermatologist may call this
medication “systemic medication.” Systemic medication is either
swallowed, injected, or infused. While effective, some of these
medications can only be used for limited time and may be combined
and rotated to minimize side effects and toxicity.
medications, excluding the biologics, approved by the U.S. Food and
Drug (FDA) Administration for the treatment of psoriasis are:
Approved to treat severe psoriasis in adults, acitretin is a
retinoid (vitamin A derivative) that patients take orally. Studies
show acitretin is effective in treating
pustular types of psoriasis. It is effective in treating
psoriasis on the palms of the hands and soles of the feet. Combining
acitretin with phototherapy has proven effective, especially in
plaque psoriasis, and allows for lower dosage. Since acitretin
does not suppress the immune system, it may be considered for
patients with severe psoriasis who are HIV-positive.
closely monitor their patients taking acitretin as side effects may
be experienced. Regular blood tests to check lipid (fat) levels are
part of this monitoring. Side effects include raised lipid levels in
the blood; severe headache; liver damage; hair loss; thinning of the
nails; sticky feeling to the skin; dry skin; bone spurs; and aches
in the muscles, joints or bone, especially during exercise.
including acitretin, should not be used by women who are pregnant or
plan to become pregnant within 3 years of discontinuing therapy due
to the possibility of severe birth defects.
How it works: Acitretin normalizes skin cells’ growth, which prevents
the rapid growth of and piling up of cells on the skin’s surface.
Effective for severe
Possible treatment for
May be used with phototherapy
to lower the dosage of acitretin
Many side effects possible,
Patients must be monitored
Cannot be prescribed to women
who plan to become pregnant within 3 years
Cyclosporine is a potent immunosuppressive drug that benefits many
with severe plaque psoriasis and psoriasis of the nails. It is taken
in pill or liquid form. While it proves extremely effective in
treating psoriasis, it is generally reserved for patients with
severe cases whose condition has not responded to other therapies.
Patients who respond typically show rapid improvement. Due to
potential side effects, kidney function and blood pressure must be
checked before the drug can be prescribed, and these need to be
monitored regularly during therapy. Other side effects include
increased risk of developing cancers, headache, tingling or burning
sensations in the arms or legs, fatigue, abdominal upset, and
musculoskeletal or joint pain.
first used to prevent rejection in organ-transplant recipients. Its
effectiveness in treating psoriasis was discovered when an organ
recipient who had psoriasis showed significant clearing after taking
cyclosporine. This finding helped confirm that psoriasis is a
dysfunction of the immune system.
The FDA recommends
that cyclosporine not be used for more than one year. Patients must
be carefully monitored, especially with long-term use. To help
patients gain relief from the signs and symptoms of psoriasis,
dermatologists may rotate cyclosporine with other systemic drugs
such as methotrexate.
How it works: Cyclosporine inhibits T cell activity, which decreases
the rapid growth of skin cells.
Possibility of severe side
effects, including kidney damage
Patient must be carefully
monitored during therapy
One of the first chemotherapy drugs, methotrexate has been used for
years to treat moderate to severe psoriasis and continues to be one
of the most effective therapies for patients with erythrodermic and
pustular psoriasis. Since methotrexate has potentially serious side
effects, tests to check kidney and liver functions and blood are run
before methotrexate is prescribed. If the tests show that the
patient is a candidate for methotrexate, the patient must be
carefully monitored during therapy. Patients take methotrexate
either orally or by injection, usually once a week.
Patients who respond
typically see an improvement within 4 to 6 weeks. After the initial
clearing, the dose may be reduced or other therapies used to keep
the psoriasis under control. Common side effects include nausea,
fatigue, and headaches. Long-term side effects include liver damage,
and patients must be closely monitored.
known to cause birth defects, so pregnancy must be avoided while
taking this medication. Methotrexate must not be taken during
pregnancy or while trying to become pregnant. Due to multiple
effects on the tissues, both men and women should stop taking
methotrexate for at least 12 weeks before trying to conceive. This
medication can be harmful to a nursing infant, so breast-feeding is
not recommended during treatment.
Methotrexate also is
not recommended for patients who have an active infection, liver
disease, or a history of alcohol abuse.
How it works: Methotrexate blocks certain parts of the immune system,
which decreases skin cell proliferation (rapid growth and
multiplication) and suppresses inflammation.
Highly effective in severe
psoriasis, especially erythrodermic and pustular psoriasis
Highly effective for
Potentially serious side
effects, including liver damage
Patients must be carefully
monitored during therapy
Gribetz, C. et al. “Clearing Psoriasis: A New Era of Optimism.”
Contemporary Dermatology 2003: Vol. 1, No. 1: 1-8.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.