Other Medications

Other treatments 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.

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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• If the drugs are effective, the cyclosporine is withdrawn gradually after a few months and acitretin continues at as low a dose as possible as maintenance.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