What is the systemic treatment for psoriasis?
For more severe forms of psoriasis, doctors sometimes prescribe medicines that are taken internally by pill or injection. This is called systemic treatment. Recently, attention has been given to a group of drugs called biologics (for example, alefacept and etanercept), which are made from proteins produced by living cells instead of chemicals. They interfere with
specific immune system processes.
Methotrexate. Like cyclosporine, methotrexate slows cell turnover by suppressing the immune system. It can be taken by pill or injection. Patients taking methotrexate must be closely monitored because it can cause liver damage and/or decrease the production of oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-enhancing platelets. As a precaution, doctors do not prescribe the drug for people who have had liver disease or anemia (an illness characterized by weakness or tiredness due to a reduction in the number or volume of red blood cells that carry oxygen to the tissues). It is sometimes combined with PUVA or UVB treatments. Methotrexate should not be used by pregnant women, or by women who are planning to get pregnant, because it may cause birth defects. Methotrexate is very effective for people with widespread psoriasis that does not respond to ultraviolet light treatment or to medications applied to the skin. It is also effective for psoriatic arthritis. Skin improvement usually begins within several weeks of starting treatment. Maximum improvement is usually seen within two to three months. Medications applied to the skin may be used to treat any remaining plaques.
Retinoids. A retinoid, such as acitretin (Soriatane), is a compound with vitamin A-like properties that may be prescribed for severe cases of psoriasis that do not respond to other therapies. Because this treatment also may cause birth defects, women must protect themselves from pregnancy beginning 1 month before through 3 years after treatment with acitretin. Most patients experience a recurrence of psoriasis after these products are discontinued. These drugs are related to Vitamin A. They normalize the growth of skin cells in psoriasis. Acitretin and isotretinoin are systemic vitamin A derivatives used in treatment of psoriasis. They are useful in treating severe forms of psoriasis, such as erythrodermic and pustular psoriasis that do not respond to other therapies.
Cyclosporine. Taken orally, cyclosporine acts by suppressing the immune system to slow the rapid turnover of skin cells. It may provide quick relief of symptoms, but the improvement stops when treatment is discontinued. The best candidates for this therapy are those with severe psoriasis who have not responded to, or cannot tolerate, other systemic therapies. Its rapid onset of action is helpful in avoiding hospitalization of patients whose psoriasis is rapidly progressing. Cyclosporine may impair kidney function or cause high blood pressure (hypertension). Therefore, patients must be carefully monitored by a doctor. Also, cyclosporine is not recommended for patients who have a weak immune system or those who have had skin cancers as a result of PUVA treatments in the past. It should not be given with phototherapy.
Alefacept (Amevive). This is the first biologic drug approved specifically to treat moderate to severe plaque psoriasis. It is administered by a doctor, who injects the drug once a week for 12 weeks. The drug is then stopped for a period of time while changes in the skin are observed and a decision is made regarding the need or further treatment. Because alefacept suppresses the immune system, the skin often improves, but there is also an increased risk of infection or other problems, possibly including cancer. Monitoring by a doctor is required, and a patient's blood must be tested weekly around the time of each injection to make certain that T cells and other immune system cells are not overly depressed. Amevive treats plaque psoriasis through a unique immunosuppressive mechanism of action. Specifically, Amevive is believed to work by simultaneously blocking and reducing the cellular component of the immune system that is thought to play a significant role in the disease process.
Hydroxyurea. This drug reduces the build-up of dead skin cells by interfering with DNA. Like methotrexate, hydroxyurea is also used to treat cancer. In psoriasis, it may have fewer side effects than methotrexate or cyclosporine but it is also less effective. It is sometimes used in combination with ultraviolet light treatment. Compared with methotrexate and cyclosporine, hydroxyurea is somewhat less effective. It is sometimes combined with PUVA or UVB treatments. Possible side effects include anemia and a decrease in white blood cells and platelets. Like methotrexate and retinoids, hydroxyurea must be avoided by pregnant women or those who are planning to become pregnant, because it may cause birth defects.
Etanercept (Enbrel). This drug is an approved treatment for psoriatic arthritis where the joints swell and become inflamed. Like alefacept, it is a biologic response modifier, which after injection blocks interactions between certain cells in the immune system. Etanercept limits the action of a specific protein that is overproduced in the lubricating fluid of the joints and surrounding tissues, causing inflammation. Because this same protein is overproduced in the skin of people with psoriatic arthritis, patients receiving etanercept also may notice an improvement in their skin. Individuals should not receive etanercept treatment if they have an active infection, a history of recurring infections, or an underlying condition, such as diabetes, that increases their risk of infection. Those who have psoriasis and certain neurological conditions, such as multiple sclerosis, cannot be treated with this drug. Added caution is needed for psoriasis patients who have rheumatoid arthritis; these patients should follow the advice of a rheumatologist regarding this treatment.
6-Thioguanine. This drug is nearly as effective as methotrexate and cyclosporine. It has fewer side effects, but there is a greater likelihood of anemia. This drug must also be avoided by pregnant women and by women who are planning to become pregnant, because it may cause birth defects.
Antibiotics. These medications are not indicated in routine treatment of psoriasis. However, antibiotics may be employed when an infection, such as that caused by the bacteria Streptococcus, triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis.
More information on psoriasis
What is psoriasis? - Psoriasis is a disease whose main symptom is gray or silvery flaky patches on the skin which are red and inflamed underneath when scratched.
What types of psoriasis are there? - Types of psoriasis include plaque psoriasis, guttate psoriasis, pustular psoriasis, erythrodermic psoriasis, flexural psoriasis, psoriatic arthritis, and nail psoriasis.
What causes psoriasis? - Psoriasis is driven by the immune system. Psoriasis is the growth of too many skin cells. The first outbreak of psoriasis is often triggered by emotional or mental stress or physical skin injury.
How is psoriasis diagnosed? - Physicians diagnose psoriasis by examining the affected skin. In people with psoriatic arthritis, the arthritis usually follows the appearance of psoriasis.
What triggers psoriasis? - Psoriasis triggers include streptococcal infection, sun exposure, drug reactions, hormonal factors, psychological factors, and skin trauma.
What are the psoriasis symptoms? - Symptoms depend on the type of psoriasis the individual has and may include bright red areas of raised patches (plaques) on the skin, tiny areas of bleeding, and itching.
What are the psoriasis risk factors? - The risks associated with developing psoriasis are similar to the triggers of the disease. The most significant risk factor for psoriasis is a family history of the condition.
What is the treatment for psoriasis? - The treatment is chosen on the basis of the pattern of psoriasis and its severity. Treatments for psoriasis can often control the disease for long periods.
What is the topical treatment for psoriasis? - Some patients with psoriasis respond well to ointment or cream forms of corticosteroids, vitamin D3, retinoids, coal tar, or anthralin. The medication that is best may depend on the type and location of the psoriasis.
What is the phototherapy treatment for psoriasis? - Phototherapy treatment for psoriasis uses ultraviolet (UV) light to kill T cells in skin, reducing redness and slowing the overproduction of skin cells that causes scaling.
What is the systemic treatment for psoriasis? - Systemic treatment for psoriasis involves taking medicines internally by pill or injection. Systemic psoriasis treatment drugs include methotrexate, retinoids, cyclosporine.
What is plaque psoriasis? - Plaque psoriasis can is a disease with very clearly defined area of skin which has a raised, red and inflamed section of skin covered in silvery scales.
What is guttate psoriasis? - Guttate psoriasis is a type of psoriasis that looks like small, salmon-pink drops on the skin. Guttate psoriasis is characterised by multiple tiny areas of psoriasis.
What is flexural psoriasis? - Flexural psoriasis is a form of psoriasis found in the armpits, groin, under the breasts and in other flexion creases (skin folds) such as those around the genitals and buttocks.
What is pustular psoriasis? - Pustular psoriasis is an uncommon form of psoriasis. People with pustular psoriasis have clearly defined, raised bumps on the skin that are filled with pus (pustules).
What is erythrodermic psoriasis? - Erythrodermic psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body surface. Erythroderma is a generalised redness of the skin.
What is scalp psoriasis? - Scalp psoriasis range from very mild with fine scaling to very severe with thick, crusted plaques. Scalp psoriasis scales appear powdery with a silvery sheen.