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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.
Common name: Methotrexate (Folex, Folex PFS, Methotrexate LPF, Rheumtrex)
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:
Note: Methotrexate should not be taken:
Common name: cyclosporine (Neoral, Sandimmune, Sang Cya)
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:
Common names include:
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:
Contraindications:
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:
Contraindications:
Common names include:
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. Sold as Dovonex in the US, 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 as Taclonex.
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.
Common names include:
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 (PPD), 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:
Serious complications may include:
Contraindications:
Whenever you are taking a prescription medication, take the following precautions:
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.
References:
American Academy of Dermatology web site. Available at: http://www.skincarephysicians.com/psoriasisnet/index.html .
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/thisTopic.php?marketID=15topicID=81 . 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.
Last reviewed November 2008 by Ross Zeltser, MD, FAAD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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