Psoriasis (cont.)

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What oral medications are available?

Oral medications include acitretin, cyclosporine, methotrexate, mycophenolate mofetil, and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare if administered.

  • Acitretin (Soriatane) is an oral drug used for certain types of psoriasis. It is not effective in all types of the disease. It may be used in males and females who are not pregnant and not planning to become pregnant for at least three years. The major side effects include dryness of skin and eyes and temporarily elevated levels of triglycerides and cholesterol (fatty substance) in the blood. Blood tests are generally required before starting this therapy and are needed periodically to monitor triglyceride levels. Patients should not become pregnant while on this drug and usually avoid becoming pregnant for at least three years after stopping this medication.
  • Cyclosporine is a potent immunosuppressive drug used for other medical uses, including organ transplantation. It may be used for severe, difficult-to-treat cases of widespread psoriasis. Improvement and results may be very rapid in onset. It may be hard to get someone off of cyclosporine without flaring their psoriasis. Because of the potential cumulative toxicity, cyclosporine should not be used for more than one to two years for most psoriasis patients. Major possible side effects include kidney and blood-pressure problems.
  • Methotrexate is a common drug used for rheumatoid arthritis, and it has been used effectively for many years in psoriasis. It is usually given in small weekly doses (5 mg-15 mg). Blood tests are required before and during therapy. The drug may cause liver damage in some patients, particularly if there is preexisting liver disease or if given for prolonged periods of time. Close physician monitoring and monthly to quarterly visits and labs are generally required.
  • FDA has recently approved a new oral drug, apremilast (Otezla), to treat psoriatic arthritis, and it seems to have an entirely novel mode of action. Although it as yet is not indicated for psoriasis, it may be in the near future.
Medically Reviewed by a Doctor on 5/2/2014

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