Antineoplastics

Common name: Methotrexate (Folex, Folex PFS, Methotrexate LPF, Rheumtrex)

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

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

Immunosuppressive Agents

Common name: cyclosporine (Neoral, Sandimmune, Sang Cya)

Cyclosporine works by suppressing certain immune functions. 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

Retinoids

Common names include:

• Tazarotene (Tazorac) (topical treatment)
• Acitretin (Soriatane) (oral treatment)

Retinoids are vitamin A related medications that may be prescribed as either topical treatments (such as gels) or oral medication. Oral retinoids are used for treating severe cases of psoriasis, while topical retinoids can be used in mild or moderate cases.

Tazarotene is used in psoriasis treatment 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.

Possible side effects include:

• Skin irritation, especially when used by itself
• Burning or stinging of the skin (severe)
• Changes in color of treated skin
• Dryness, itching, peeling, or redness of the skin (severe)
• Pain or swelling of treated skin

Contraindications:

• 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

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 2 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

Topical Medications

Common names include:

• Corticosteroids
• Calcipotriene
• 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.

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.

Calcipotriene

Calcipotriene is a synthetic form of vitamin D used for treating mild to moderate psoriasis. Sold as Dovonex in the US, 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 as Taclonex.

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.

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.

Biologic Response Modifiers

Common names include:

• Etanercept (Enbrel)
• Infliximab (Remicade)
• Alefacept (Amevive)
• Efalizumab (Raptiva)
  • Note: In April 2009, the manufacturer of efalizamab (Raptiva) voluntarily decided to remove it from the market. The medication has been linked to a rare brain infection that can be life-threatening. If you are currently taking Raptiva, talk to your doctor about other treatments.

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 TNF, a pro-inflammatory cytokine implicated in the development of psoriasis, or by inhibiting inflammatory cell activation in the skin. All patients receiving these medications must first undergo a skin test for tuberculosis (PPD), 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
• Fever
• Nausea
• Myalgia (muscular pain or tenderness)
• Injection site reactions

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

Contraindications:

• Known chronic infections
• Allergy to any of the medication components
• Low white blood cell counts