Psoriasis - Other Medications

Highlights	Diagnosis	Managing Psoriasis
Introduction	Treatment	Resources
Causes	Topical Medications	References
Risk Factors	Other Medications
Prognosis	Phototherapy

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Other Medications

Othertreatments for psoriasis may be taken by mouth (oral) or given by a shot (injected).These drugs are called "systemic" because they affect the entire body. Many of the systemic drugs used for psoriasis are also used for other severe diseases, including autoimmune diseases (especially rheumatoid arthritis) and cancer. Nearly all are powerful medications with potentially serious side effects. These drugs should be used only for severe incapacitating cases of psoriasis that do not respond to lifestyle changes or topical (or other less potent) therapies. And they should be used only in very extreme circumstances in children.

As with all medications for psoriasis, the least potent agents should be used first:

Methotrexate and oral retinoids are the first-line, or primary, systemic drugs for adults with severe psoriasis. Cyclosporine is also an option.
Second-line drugs include hydroxyurea, sulfasalazine, and thioguanine.
Third-line agents include tacrolimus.

At this time, the only agents specifically approved for psoriasis are methotrexate, the retinoids, and cyclosporine.

Systemic Regimens. As with all psoriasis treatments, combinations are often used. The following is an example of a systemic regimen with combination treatments:

The patient starts with an immunosuppressant, such as cyclosporine.
Acitretin, a vitamin A derivative, is then added (the transitional phase).
If the drugs are effective, the cyclosporine is withdrawn gradually after a few months and acitretin continues at as low a dose as possible as maintenance.
Phototherapy using PUVA is added if acitretin cannot control psoriasis.

Methotrexate

Methotrexate (Rheumatrex) is very effective for severe psoriasis. Despite its adverse effects, some experts view methotrexate as the best therapy for widespread plaque psoriasis. It may also be effective for some patients with other severe forms of the disease, including psoriatic arthritis, generalized erythrodermic and pustular psoriasis. For example, one center reported that 80% of patients reported prolonged improvement. Methotrexate appears to be effective in children, but more safety research is needed.

It has the following beneficial properties:

It interferes with cell reproduction.
It has anti-inflammatory properties.
It is one of the few systemic agents proven to help patients with psoriatic arthritis.