Overview
Systemic treatments for psoriasis include: psoralen with Ultraviolet (UV) A light (PUVA), methotrexate, acitretin, and cyclosporine. Systemic drugs are usually either taken by mouth or injected and affect the entire body, while topical drugs affect only the local area on which they are applied (i.e., the skin surface).
Detailed Description
PUVA
The acronym PUVA stands for psoralen with UVA light therapy. It is the least toxic of all the systemic treatments. The patient swallows 9- methoxypsoralen, a compound that causes the skin to be photosensitive. About 1 hour after ingestion, the patient is exposed to UVA light. Doses of UVA light are adjusted according to your skin type. Typically 2 to 3 treatments per week are given, and most patients will improve greatly after 20 treatments. Long- term side effects include skin damage and premature aging that mimic the effects of chronic sun exposure, as well as an increased risk of developing skin cancers.
Methotrexate
Methotrexate is an oral medication that inhibits cell division and proliferation and is very effective in controlling psoriasis. It is usually given once a week, so this treatment is very convenient for patients. The major side effects include liver toxicity and abnormal blood cell counts. Therefore, frequent laboratory tests for liver enzymes and blood cells are necessary before and during treatment. This medication should not be used in children or patients with liver disease, abnormal liver enzymes, or IV drug use. In addition, alcohol intake must be avoided or liver damage may ensue. Remember to tell your dermatologist what other medications you are taking because methotrexate interacts with many other drugs.
Acitretin
Acitretin (Soriatane) is an oral retinoid that is particularly effective for pustular psoriasis. It can be used alone or with PUVA for added effect. Like other systemic retinoids, acitretin is a teratogen, meaning that it is known to cause serious birth defects. Therefore, women must take strict birth control precautions including frequent pregnancy tests. Other side effects include drying of the skin and mucous membranes, peeling of the palms and soles, and possible effects on bones, eyes, liver, and blood lipid levels.
Cyclosporine
Systemic cyclosporine (Neoral) is a drug that was first approved to prevent rejection of transplanted organs in organ recipients. It is also effective in treating psoriasis but should be reserved for severe cases that do not respond to other therapies. The most significant side effect of the drug is toxicity to the kidney, but other effects involve the nervous system, the gut, lipid levels, and hair and nails.
Related Conditions
Psoriasis
Related Procedures
Psoriasis- Topical treatments
Last updated: 23-Apr-02
