Woman with gray hair and a gray sweater puts medication in her mouth, a glass of water in her other hand

How to Reduce Psoriasis Medication Side Effects

By Beth W. Orenstein
Reviewed by Allison Truong, M.D.
April 15, 2024

When you have psoriasis, it’s important to follow your treatment plan as directed by your doctor. That’s because keeping up with your treatment plan can help prevent flares or recurrences, says Sabrina Barata, M.D., a board-certified primary care doctor at Mercy Personal Physicians in Lutherville, Maryland.

While the benefits of treatments are clear, psoriasis medications—like any medication—may have risks and potential side effects. Knowing what side effects could occur—and what to do if they do occur—is important for managing your psoriasis so that you can continue to feel your best.

What Side Effects May Be Possible?

The possible side effects of psoriasis medications can be relatively minimal, like skin irritation (dermatitis or folliculitis) and stretch marks, Barata says. Or they can be more significant, says board-certified dermatologist Paul S. Yamauchi, M.D., Ph.D., clinical assistant professor of dermatology at the David Geffen School of Medicine at the University of California, Los Angeles. These can include side effects like vomiting, diarrhea, urinary tract infection, headache, and fever.

Everyone reacts differently, and the potential side effects may depend on the type of medication.

For example, topicals may be more likely to cause skin-specific side effects, like skin irritation, and systemic medications may be more likely to cause systemic issues, like nausea or stomach upset. Most doctors are able to share with you the most common side effects of a medication; however, it’s impossible to go through every single side effect that has ever been seen or reported.

“The good news,” Yamauchi says, “is that while side effects can be unpredictable, they will disappear and are not permanent in the majority of cases.”

Tips for Reducing Side Effects of Psoriasis Medication

You don’t have to let fear of potential side effects stop you from starting a new treatment or continuing with treatment that’s working, Barata says.

It’s important to remember that the medications have undergone rigorous testing in large clinical trials before becoming available for your use. Also, most people have little to no side effects from psoriasis medications. And in the case that you do have an unexpected reaction, it’s typically reversible. Here are strategies you can use to help avoid or reduce side effects.

Talk to Your Doctor

If you experience psoriasis medication side effects that you find unpleasant or intolerable, talk with your provider, Barata says. They may be able to tweak or change your medications for the best results.

You shouldn’t stop taking medication without consulting your doctor, either. That’s because some medications need to be tapered slowly to reduce the risk of worsening psoriasis symptoms.

Use As Prescribed

“To limit side effects of any treatment, make sure you’re using the medication exactly as prescribed,” says board-certified dermatologist Frank Morocco Jr., D.O., of OhioHealth Physician Group in Marion, Ohio. “Some medications are used for maintenance, and some are used for flares. It’s crucial to know your treatment plan and stick to it so that you maximize outcomes and reduce side effects.”

Along those lines, it’s important to take your medication not only in the prescribed amount but also at the right times, according to the U.S. Food and Drug Administration.

Topical corticosteroids commonly used for mild to moderate psoriasis have different strengths, and your doctor should tell you where and how to apply them to minimize potential side effects. For example, strong topical steroids, such as clobetasol ointment, should generally not be used on the face or folds of the skin because it can cause acne or skin thinning known as atrophy. If you’re unsure, ask your doctor about the strength of the one you were prescribed, the National Psoriasis Foundation (NPF) recommends.

Go for Bloodwork As Needed

Some oral medications prescribed for psoriasis, such as methotrexate or cyclosporine, may require monitoring because they’re processed and cleared by the liver or kidneys. If you’re on any of these medications, you and your doctor should discuss regular blood testing or imaging (such as a liver ultrasound) to detect any early signs of stress to your liver or kidneys. These tests may help your doctor determine whether it’s safe for you to continue on that prescribed medication, the NPF says.

Older medications (usually oral systemic agents) may require more testing to check on kidney or liver function than do newer medications, such as injectable biologics. Talk to your doctor about switching to newer medications if trips to the clinic or lab for monitoring is a hassle for you, Morocco notes.

Watch for Signs of Infection

People taking biologics, oral systemics, and other medications that suppress the immune system have reported more minor infections than the general population, Yamauchi says. Minor infections can be treated, especially if addressed early. And, Yamauchi adds, the likelihood of their happening decreases over time.

Signs of infection to watch for include:

  • Fever
  • Chills
  • Clammy sweating
  • Congestion in the nose or chest
  • Burning when you urinate
  • Urinating more frequently than usual
  • New rashes
  • Sores on the lips or genitals that aren’t healing

If you begin to experience any of these symptoms, let your doctor know as soon as possible. Infections may include upper respiratory tract infections, such as the common cold or flu; urinary tract infections; pneumonia; bacterial skin infections; viral skin infections; or fungal or yeast infections. You may need treatment such as antibiotics or anti-inflammatories.

How to Know Whether It’s Time to Switch

Some psoriasis medication side effects will resolve on their own with time, Yamauchi says. But if after a few weeks the side effects continue and you want to try a different treatment, talk to your doctor. Today, there are many options for treating psoriasis, whether it’s mild, moderate, or severe. Your doctor can help determine whether another medication may be better for you.

Before you start any treatment, you and your doctor should go over the correct dosage and what you should do if you should experience a flare-up, Barata says. Knowing “the instructions” will make sticking with treatment easier, she adds.

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