Systemic treatments are any form of therapy that is delivered orally (in tablet or liquid form) or through injection or intravenous infusion (drip), that work within the body as opposed to topical treatments, which are applied directly to the skin.
Apremilast
Apremilast is an immuno-suppressant that is delivered in an oral tablet that reduces the activity of PDE4. This results in less inflammation in the skin and joints.
Potential side effects
The most common side effects include diarrhea, nausea, vomiting, headache, upper respiratory tract infection (e.g. common cold) and flu (body aches and pains, tiredness, fever.) Other complaints may include decreased appetite, abdominal discomfort, indigestion, fatigue, trouble sleeping, back pain, dizziness, depression and weight loss.
Cyclosporine
Cyclosporine suppresses immune responses. It has long been considered one of the most effective treatments for psoriasis for some people. Doctors usually prescribe cyclosporine for patients with severe flares or when psoriasis rebounds after other treatments. It often clears the skin rapidly.
Potential side effects
Long-term use of cyclosporine carries a risk of kidney, liver and other problems, such as lymph node cancer, increased blood pressure, and skin cancer. Therefore cyclosporine is usually limited to short courses and is not usually taken for longer than a year or two, at most. This medication interacts with numerous drugs, so you should tell your doctor about other medications and supplements that you take.
Other potential side effects include hypertension, hair overgrowth, headache, higher risk of infection, muscle/bone aches and pains, tremor, tiredness, cough, runny nose, shortness of breath, stomach pain, nausea, vomiting, diarrhea, numbness or tingling in the skin, loss of strength and more. Routine blood tests are prescribed to monitor metabolic problems such as too much magnesium or uric acid in the blood.
Methotrexate
This drug has treated moderate to severe psoriasis for more than 50 years. Metho-trexate works by suppressing the immune system—stopping the body from attacking itself—in ways that prevent skin inflammation that leads to psoriasis. It can be very effective and some patients respond very well and take it for many years.
Potential side effects
Although effective in many patients, methotrexate may carry a higher risk of infection because it suppresses the immune system.
Common potential side effects include nausea, anorexia, mouth ulcers and tiredness. More serious potential side effects include liver, kidney, lung, and bone marrow problems. Many experts recommend that people take folate supplements while on this medication to avoid gastrointestinal and bone marrow problems.
This medication is not for everyone; doctors do not prescribe it to pregnant or nursing women or people with liver or kidney problems, hepatitis, leukemia, or a history of not taking their drugs or alcoholism. People who take methotrexate must have periodic blood tests to check for liver problems and other side effects.
Drug interactions with the following medications should be considered:
- Common NSAIDs, such as ibuprofen, salicylates, naproxen, indomethacin and phenylbutazone
- Common antibiotics, including penicillins, sulfonamides, trimethoprim/ sulfamethoxazole, minocycline and ciprofloxacin
- Thiazide diuretics, sulfonylureas, phenytoin, barbiturates, furosemide
Retinoids
Oral retinoids, such as acitretin, are derived from vitamin A. They are usually reserved for the treatment of severe psoriasis that covers more than 10% of the body or causes physical, occupational or psychological disability. They are particularly helpful for palm and sole psoriasis. Oral retinoids are often combined with UVB or PUVA phototherapy and biologic therapy for greater benefits.
These medications work by slowing the growth of skin cells, preventing skin from swelling and interrupting the body’s attack on itself. When combined with other agents, they work synergistically, enabling the use of lower doses of each drug.
Oral retinoids are safe for long-term use and are often prescribed as maintenance therapy.
Potential side effects
Potential side effects include eye, mouth or nose dryness, nosebleeds, dry skin, swollen or cracked lips, brittle nails, hair loss, nausea, stomach ache, muscle or joint pain, pins-and-needle sensations and itchy, burning, or sticky skin.
Oral retinoids must not be used in women of childbearing age unless they use a reliable form of contraception. Because the drug persists for long periods in the body, women should avoid becoming pregnant while taking acitretin and for a full three years after they have stopped taking it. Women who are nursing also should not take acitretin.
Routine blood tests are used to monitor cholesterol and triglyceride levels as well as liver and kidney function.
Drug interactions are possible with other psoriasis medications—such as cyclosporine—and people must avoid supplements that contain vitamin A to prevent overdose.
For a comparison of Systemic Medications see Systemic Treatments Table.
