Topical Medications

Common names include:

• Corticosteroids
• Tazarotene—topical
• Calcipotriene
• Calcitriol
• 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. They be used in combination and with other forms of treatment.

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.

Vitamin D analogs

Calcipotriene and calcitriol are synthetic forms 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.

Retinoids

Tazarotene is used in treatment of mild to moderate psoriasis 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

• 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

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 side effects may include:

• Skin irritation and rash
• Itching and skin discomfort
• Dryness or thinning of the skin

Oral Systemic Medications

Methotrexate

This medication suppresses the immune system. 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.

It is taken on a weekly (NOT daily) basis, in either oral or injectable form

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

Cyclosporine

Cyclosporine works by suppressing certain immune functions and reducing the growth of skin cells.

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

Note: These drugs should not be taken:

• By women who are pregnant or nursing
• By men who want to get their partner pregnant (methotrexate gets into sperm)
• In people with
  • alcoholism, alcoholic liver disease, or other chronic liver diseases
  • abnormal kidney function
  • abnormal kidney function
  • uncontrollable high blood pressure
  • cancer or a history of cancer
  • reduced immune function
  • active infection

Acitretin

Acitretin is a retinoid which are vitamin A related medications. It is not know how it works.

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 3 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

Apremilast

Apremilast is phosphodiesterase 4 (PDE4) enzyme inhibitor that reduces inflammatory action in the cells

Possible side effects include:

• Gastrointestinal problems, including diarrhea, nausea and vomiting
• Headache
• Upper respiratory infection
• Depression
• Weight loss

Tofacitinib

Tofacitinib is a Janus kinase enzyme inhibitor that reducess inflammatory action in the cells

Possible side effects include:

• Upper respiratory infection
• Headache
• Diarrhea
• Cold or flu-like symptoms
• Weight loss

Rare complications may include:

• High lipid levels, including cholesterol
• High liver enzymes
• Low blood counts
• Lymphoma and other malignancies
• Gastrointestinal perforations

Biologic Response Modifiers

Common names include:

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

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 factors causing the inflammation implicated in the development of psoriasis, including:

• Pro-inflammatory cytokines—TNF (tumor necrosis factor) or interleukins
• T cells—a type of white blood cell that is also involved inpsoriatic arthritis

These treatments inhibit inflammatory activation and may reduce excessive skin growth.

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
• Upper-respiratory infections
• Fungal infections

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
• A lowered immune system