Psoriasis - Other Medications

Despite these side effects, oral retinoids remain among the safest systemic therapies for psoriasis. A low-fat diet, aerobic exercise, and fish oil supplements may help reduce the side effects.

Oral Retinoids and Pregnancy

Retinoids taken by pregnant women pose a significant risk for severe birth defects in the unborn child. Pregnant or nursing women or those planning to become pregnant should not use these drugs. Women of childbearing age who take retinoids should have regular pregnancy tests. There are some differences in retinoid effects, however.

Acitretin is cleared from the body in about three or four weeks, so the agent does not to appear to pose a for birth defects beyond that time. There is one important exception: Drinking alcohol converts acitretin to etretinate, which is a retinoid that is stored in fat cells for three years. Therefore, it may have the potential for causing birth defects during that time. Therefore, if a woman drinks alcohol while taking acitretin or any time during the two months after she stops, she must wait three years to conceive. Note some cooking products and over-the-counter preparations, such as cough syrup, may contain alcohol and be inadvertently ingested. Some experts, then, advise that acitretin not be given to any woman-regardless of alcohol use, who may become pregnant within three years of taking it.
Isotretinoin is safer for women who wish to become pregnant since it is safely gone from the body within a month. The interaction with alcohol is not totally known, but the wisest route is to avoid alcohol and all alcohol-containing products when taking it.

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Cyclosporine

Cyclosporine (Neoral, Sandimmune, SangCya) blocks certain immune factors and may be effective for all forms of psoriasis. Neoral is the preparation used most often for psoriasis and clears psoriasis in between 60 - 91% of patients within eight to 12 weeks. Cyclosporine has significant side effects if used for a long time, notably kidney problems and nonmelanoma skin cancers. It should be reserved for patients who do not respond to phototherapy or less potent systemic agents (e.g., methotrexate or acitretin).

Side Effects. Common and temporary side effects include headaches, gingivitis, joint pain, gout, body hair growth, tremor, and fatigue.

More serious complications may include the following.

Kidney damage. This is a significant complication and prolonged use always causes some kidney injury.
High blood pressure (occurring in up to 30% of patients). Some experts advise treating high blood pressure with calcium-channel blockers, since other standard anti-hypertensive drugs may worsen psoriasis. Calcium channel blockers also help prevent kidney problems.
Unhealthy cholesterol and lipid levels. Patients may need to take cholesterol-lowering agents.
Abnormalities in the liver.
Increased risk for infections.
Skin cancers. Patients who have taken cyclosporine after PUVA therapy have a higher incidence of squamous cell carcinoma. According to a 2003 study, the risk is six times that of the general population. The risks are highest with long duration and previous use of PUVA, methotrexate, or other immunosuppressants.
Lymphomas. The use of cyclosporine after transplantation has been associated with a higher risk for lymphomas, although whether cyclosporine used for skin diseases poses any higher risk is unknown.
High levels of calcium and low levels of magnesium. These effects can usually be offset with magnesium supplements and eating potassium rich foods.