Psoriasis - Other Medications

Systemic Medications

Systemic treatment uses various medications that affect the whole body, not just the skin. Many systemic drugs used for psoriasis are also used for other severe diseases, including autoimmune diseases (especially rheumatoid arthritis) and cancer.

Systemic treatments for psoriasis may be taken by mouth or injection. The medicines can have significant side effects and are generally reserved for severe psoriasis.

Systemic medications approved for treating psoriasis include:

• Cyclosporine
• Methotrexate
• Retinoids
• Biologic Response Modifiers
• Psoralen

As with all medications for psoriasis, patients should use the lowest strength medication first. The primary treatment is called a first-line treatment, the next is known as a second-line treatment, and so on. Combinations of medications are often used.

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Methotrexate

Methotrexate (Rheumatrex) is a biologic drug that interferes with cell reproduction and has anti-inflammatory properties. It is a first-line, or primary, systemic drug used to treat adults with severe psoriasis.

The drug is taken weekly, not daily.

Side Effects. Many patients are able to tolerate methotrexate with few side effects. Possible side effects include:

• Anemia, usually causing no noticeable symptoms
• Headache
• Mild and slow hair loss that is reversible when the medication is stopped
• Increased likelihood of becoming sunburned
• Mouth sores
• Nausea, usually mild and improves over time
• Possible muscle aches
• Rash
• Vomiting (rare)

Many of these side effects are due to folic acid deficiency. Patients should ask their doctor if they should take folic acid supplements (generally recommended at 1 mg daily).

More serious, but relatively uncommon side effects include:

• Increased risk for infections, particularly shingles and pneumonia. Methotrexate suppresses the immune system. Patients with active infections should avoid this drug.
• Infertility, miscarriage, and birth defects. This drug should not be used during pregnancy, because it can cause miscarriages or birth defects. It may harm fertility in men.
• Kidney damage.
• Liver damage, most commonly in patients with existing liver problems. Regular monitoring for liver toxicity includes blood tests and sometimes liver biopsies. Patients who are properly monitored rarely have any permanent liver damage.
• Cough and shortness of breath. Risk factors for these side effects include diabetes, existing lung problems, protein in the urine, and the use of rheumatoid arthritis drugs of a type called DMARD.
• Severe anemia. Folic acid supplements can offset this effect.
• Toxic effects on bone marrow. This can cause reduced blood cell production.