Psoriasis Medications and Their Side Effects


Psoriasis Medications and Their Side Effects

Common Psoriasis Drugs

There are many drugs on the market for the treatment of psoriasis. Your doctor will always assess the benefits versus risks when prescribing them, but it’s best to review with your health care provider or pharmacist when you start taking a new drug so you are fully aware of the safety profile of your medication.

While no drug can cure this condition, medication can help alleviate the symptoms. You will often receive a combination of drugs, rather than a single medicine. Your GP may recommend you see a dermatologist or a rheumatologist (for psoriatic arthritis) to ensure you get the optimal treatment.

Below are some of the most commonly prescribed drugs, including some of their side effects:

Topical Medications

  • Topical corticosteroids – These come in various strengths, from the 1% over-the-counter hydrocortisone cream to high-potency steroid creams available by prescription. This cream is applied on the skin to decrease the inflammation. Common side effects of steroid cream are more likely to occur if used long term, and include thinning of the skin and stretch marks.
  • Calcipotriene and calcitriol – These can be used as an alternative or in combination with topical steroids. These drugs are related to vitamin D and have a good safety profile. The most common side effect is skin irritation.
  • Tazarotene – This is a vitamin A derivate and is also applied on the skin, available as a cream or gel. Results are not seen right away – it may take two months to notice improvement. There is also a risk of skin irritation; if irritation develops your doctor may tell you to apply the cream on the skin and then wash it off after 20 minutes.

Oral Medications

  • Methotrexate – This drug works by suppressing the immune system and is indicated to manage moderate to severe psoriasis affecting the skin or joints; it is available as a pill or injection. This drug can affect the function of your liver and therefore liver tests should be done regularly. Other side effects include sore mouth and stomach irritation, however these symptoms can be reduced by taking folic acid supplements. Serious adverse reactions are rare, but they can happen and include lung, liver and bone marrow damage, and even death. This drug interacts with other medications (i.e. some antibiotics), with alcohol and should not be taken during pregnancy.
  • Retinoids – Retinoids are prescription drugs derived from vitamin A, and are usually indicated in severe psoriasis. Side effects associated with this drug include dry, crackling skin and lips, vision problems, nose bleeding, hair loss, depression, liver damage and abnormal triglyceride levels. Like methotrexate, retinoids are contraindicated during pregnancy due to the risk of birth defects.

Injectable Medication

The newest drugs used in psoriasis are so called “biologics” – for example etanercept, infliximab, adalimumab, and ustekinumab and secukinumab. They suppress the immune system, are very effective, but also very expensive and have high risk of adverse reactions.

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Therefore, biologics are mostly used when the other treatments fail, and the treatment is closely monitored by the doctor. Serious side effects include serious bacterial infections, nerve disorders (including multiple sclerosis), severe allergic reactions and aggravation of the heart failure.

Resources

UpToDate (Patient information: Psoriasis (Beyond the Basics))

American College of Rheumatology (Biologic Treatments for Rheumatoid Arthritis)

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