INFOGRAPHICPSORIASIS

Systemic Treatments for Psoriasis

March 17, 2023
WHAT ARE SYSTEMIC TREATMENTS? Systemic treatments are medications that work throughout the entire body, not just on the skin. They may be prescribed to people with moderate to severe psoriasis who don’t improve with topical treatments alone or people whose quality of life is severely impacted. Types of Systemics There are two main types of systemic treatments for psoriasis. Oral medications: These “traditional” systemics come in pill form. You may have heard of Cyclosporine, Methotrexate, Otezla, or Soriatane. Biologic therapies: These are given by injection, or sometimes by IV infusion. You may have heard of Cimzia, Cosentyx, Enbrel, Humira, or Siliq. (There are more too!) Biosimilars are drugs that are nearly identical to biologics with similar effectiveness but that are manufactured differently and may have slight differences. HOW DO THEY WORK? Both traditional oral and biologic treatments ease symptoms by reducing the overactive immune response that’s causing inflammation throughout the body. Be Patient Like all new treatments, it can take systemic medications some time to work. How much time depends on the drug, but the goal is usually to reduce psoriasis down to no more than 1% of your body’s surface area within three months. WHAT ABOUT SIDE EFFECTS? Oral medications can cause some side effects that are important to watch out for. Short-term options: Some systemic medications are prescribed for only short periods of time to prevent side effects. For example, taking Cyclosporine for longer than a year can increase risk of serious infections, high blood pressure, and kidney disease. Other risks: Methotrexate may be prescribed for severe psoriasis, but some possible side effects include liver damage, lung damage, and a higher risk of a type of cancer called lymphoma. Pregnancy: It’s really important to tell your doctor if you’re pregnant, breastfeeding, or trying to become pregnant. Some systemic drugs can cause serious birth defects and aren’t recommended for use during pregnancy or breastfeeding. Before starting any medication, it is important to ask your doctor about side effects you need to be aware of. Biologic therapies have very few side effects. There may be small increases in rates of some infections and cancers; but, in general, they’re considered to be low-risk. TAKING SYSTEMIC MEDICATIONS Before taking your medication, ask your doctor to clearly explain: • Instructions on how to take the meds • Dosing amounts • How often to take it Combination Treatment Even if you start on a systemic medication, you might continue using other treatments, such as topicals or phototherapy. This could mean taking each one at a lower dose, which reduces the risks and side effects. SOURCES Bagel, J. and Stein Gold, L. (2017) Combining Topical Psoriasis Treatment to Enhance Systemic and Phototherapy: A Review of the Literature. Journal of Drugs in Dermatology. Menter, A., et al. (2020) Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. Journal of the American Academy of Dermatology. National Psoriasis Foundation, “Treat to Target.” National Psoriasis Foundation, “Systemics.” National Psoriasis Foundation, “Cyclosporine.” MedlinePlus, “Methotrexate.” Mayo Clinic, “Psoriasis: Diagnosis & treatment.”