Psoriasis - Other Medications

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Accutane, more commonly used to treat acne, is far less potent than acitretin, but it may still be effective against pustular psoriasis. The drug may also be effective with phototherapy.

Oral retinoids help control cell reproduction and have anti-inflammatory properties. They may even improve arthritis that accompanies psoriasis.

Combination therapy. Acitretin may work best when combined with other treatments, usually topical drugs and especially phototherapy. Combination therapy allows lower doses of oral retinoids to be used, which diminishes many skin and mucus membrane side effects. Acitretin combined with phototherapy has some of the greatest success rates of any treatment.

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Side Effects. All retinoids have the same potentially serious toxicities, as do high doses of vitamin A. Side effects include:

• Bone and joint pain
• Bruising
• Depression and possible suicide risk (with isotretinoin)
• Eye problems, including blurred vision, cataracts, conjunctivitis, and a sudden deterioration in night vision
• Fatigue
• Headache
• Increased bone growth, particularly in the ankles, pelvic area, and knees
• Increased triglyceride levels
• Liver damage
• Nail problems
• Skin and mucus membrane problems, including dry nose, nosebleeds, dry eyes, chapped lips, thinning hair, dry or "sticky" feeling skin, and peeling of the palms and soles

In rare cases, retinoids, particularly isotretinoin, may cause a condition called benign intracranial hypertension (pseudotumor cerebri), which occurs in the brain. Symptoms include headache, nausea, vomiting, and blurred vision. Patients experiencing these symptoms should call a doctor immediately and stop taking the drug.

Oral retinoids should not be taken during pregnancy.

Despite these side effects, oral retinoids remain among the safest whole-body therapies for psoriasis. A low-fat diet, aerobic exercise, and fish oil supplements may help reduce the side effects. Certain cholesterol-lowering drugs, including gemfibrozil (Lopid) or certain statins, such as atorvastatin (Lipitor), may help control triglyceride levels.