Medications

Psoriasis medications slow down or normalize excessive cell growth and reduce inflammation associated with psoriasis. They include “topical” medications that are applied to the skin, and “oral” medication that are taken by mouth.

Although some topical medications are available over-the-counter (OTC) without a prescription, stronger therapies are available by prescription only. Corticosteroids are the most commonly prescribed topical medication for psoriasis.

Oral medications for psoriasis are available by prescription-only. They are considered to be in the category of “systemic treatments,” because they affect the entire body. This makes them especially useful when psoriasis lesions are scattered over a widespread area, making it difficult to apply topical medication to all of the affected skin.

Oral medications are usually prescribed for people with moderate, severe, or disabling psoriasis who do not respond or cannot use topical medications or ultraviolet (UV) light treatments.

Oral medications are frequently prescribed in combination with other medications. Many have serious side effects and must be combined or rotated with other therapies to maximize effectiveness and minimize side effects.

Topical Psoriasis Medications (Available by Prescription Only)

• Anthralin (Micanol) – An established, safe treatment for psoriasis (especially of the scalp), anthralin slows down skin cell growth and reduces inflammation. The medication may stain clothing and non-affected skin.
• Calcipotriene (Dovonex, Taclonex) – This synthetic form of vitamin D slows skin cell growth, flattens psoriasis lesions, and removes scales. While it doesn’t address inflammation specifically, most patients notice a reduction of skin redness.
• Calcitriol (Vectical) – Vectical contains calcitriol, the naturally occurring and active form of vitamin D3. This topical psoriasis treatment slows down the over production of skin cells that occurs with psoriasis, and it is thought to help decrease the excessive immune response on the skin of patients with psoriatic lesions. Because it is well-tolerated, Vectical may be prescribed for use on skin folds.
• Corticosteroids (“topical steroids”) – Corticosteroids slow skin cell growth and relieve itching by suppressing the immune system. They work quickly and are easy to use. They may be used alone for mild psoriasis or combined with other therapies for severe lesions. Side effects include thinning of the skin, stretch marks, and reduced immune function, so prolonged use should be avoided.
• Topical retinoids (Tazorac) – Retinoids are a class of medications derived from vitamin A that are used for a variety of skin conditions. Some retinoids, such as Tazorac, have been formulated for application to the skin. (Oral retinoids, such as Soriatane, are taken by mouth.) Tazorac is FDA-approved for the treatment of psoriasis and helps slow the growth of quickly multiplying skin cells.
• Calcineurin inhibitors (Elidel, Protopic) – These medications, typically used for atopic dermatitis (eczema), may be prescribed in some cases of psoriasis.

Oral Psoriasis Medications (Available by Prescription Only)

Oral medications may be prescribed for people with moderate to severe psoriasis whose lesions don’t respond sufficiently to topical medications or phototherapy. Because they are taken by mouth and absorbed into the blood, they reach the deeper layers of skin throughout the body. They can be very effective but have serious potential side effects to consider.

Systemic treatments include:

• Cyclosporine (Neoral) — By suppressing the immune system, cyclosporine slows the overgrowth of skin cells and is particularly effective against plaque and nail psoriasis. Because of cyclosporine’s significant side effects, people taking this medication are monitored closely.
• Methotrexate — Like cyclosporine, this medication suppresses the immune system and is sometimes prescribed for the treatment of erythrodermic and pustular psoriasis, as well as psoriatic arthritis. Because of methotrexate’s significant side effects, people taking this medication are monitored closely.
• Soriatane (acitretin) — “Retinoids” refers to a class of medications derived from vitamin A that are used for a variety of skin conditions. Soriatane is retinoid that is FDA-approved specifically for the treatment of multiple types of psoriasis. It is often combined with other treatments, including calcipotriene (Dovonex, Taclonex) and phototherapy. Soriatane is particularly useful for severe psoriasis, but it has significant side effects, including chapped lips and dry skin. Because the medication can cause serious birth defects, women who might become pregnant must have two negative pregnancy tests before starting treatment, use two forms of birth control during treatment, and continue birth control for three years after stopping the medication.

Other systemic treatments that might be considered include isotretinoin (Accutane, Sotret), hydroxyurea, mycophenolate (Cellcept), and sulfasalazine.

Combination therapy

Some cases of psoriasis require combining different therapies for improved results. For instance, Tazorac may be combined with a topical steroid, or Soriatane may be combined with phototherapy. Your doctor may recommend different combinations at different times.

Rotating therapies

Long-term use of some medications, such a cyclosporine or methotrexate, can lead to an increased risk of side effects. In addition, the benefits of some medications can diminish over time. In such cases, doctors may recommend rotating medications, using one medication for several months followed by another. For example, coal tar may be rotated with cyclosporine.