What Oral Medications Are Available for Psoriasis?

Medically reviewed by Debra Sullivan, PhD, MSN, CNE, COI on October 21, 2016Written by Kimberly Holland

Understanding psoriasis

Psoriasis is a common skin condition that affects 7.5 million people in the United States. This autoimmune disorder causes red, thick, inflamed patches of skin. The patches are often covered in whitish silvery scales called plaques. In some cases, the affected skin will crack, bleed, or ooze. Many people feel burning, pain, and tenderness around the affected skin.

Psoriasis is a chronic condition. Even with treatment, psoriasis will never fully go away. Instead, treatment aims to reduce symptoms and to help the disease enter remission. Remission is a period of little to no disease activity. This means there are fewer symptoms.

Oral medication is a powerful treatment option.

What oral medications are available for psoriasis?

Oral drugs are a form of systemic treatment, which are very strong. Doctors often only prescribe systemic treatments for severe psoriasis. In many cases, these powerful drugs are reserved for people who haven’t had much success with other psoriasis treatments. Unfortunately, they can cause a variety of side effects and issues.

Learn more about the most common oral medications.

Option #1: Acitretin

Acitretin (Soriatane) is an oral retinoid. Retinoids are derivatives of vitamin A. This drug is the only oral retinoid used to treat severe psoriasis in adults. It can cause serious side effects. Because of this, your doctor may only prescribe this medication for a short time. When your psoriasis enters remission, your doctor may tell you to stop taking this drug until you have another flare-up.

The most common side effects include:

  • chapped skin and lips
  • hair loss
  • dry mouth
  • aggressive thoughts
  • changes in your mood and behavior
  • depression
  • headache
  • pain behind your eyes
  • joint pain
  • liver damage

Serious side effects can happen in rare cases. Call your doctor right away if you experience any of the following:

  • a change in vision or a loss of night vision
  • bad headaches
  • nausea
  • shortness of breath
  • swelling
  • chest pain
  • weakness
  • trouble speaking
  • yellowing of your skin or the whites of your eyes

Be sure to discuss your reproductive plans with your doctor before you begin taking acitretin. This drug can cause problems with some birth control methods. You shouldn’t take this drug if you’re pregnant or planning to become pregnant within the next three years.

If you’re a woman who could become pregnant, you shouldn’t drink alcohol while taking this medication and for two months after you stop taking it. Combining acitretin with alcohol leaves behind a harmful substance in your body. This substance could fatally harm future pregnancies. This effect lasts for up to three years after you finish treatment.

Option #2: Cyclosporine

Cyclosporine is an immunosuppressant. It’s often marketed as the medications Neoral, Gengraf, and Sandimmune. It’s used to treat severe psoriasis if other treatments don’t work.

Cyclosporine works by calming the immune system. It prevents or stops the overreaction in the body that causes symptoms of psoriasis. This drug is very strong and can cause serious side effects.

The most common side effects include:

  • headache
  • fever
  • stomach pain
  • nausea
  • vomiting
  • unwanted hair growth
  • diarrhea
  • shortness of breath
  • slow or fast heart rate
  • changes in urine
  • back pain
  • swelling of your hands and feet
  • unusual bruising or bleeding
  • excessive tiredness
  • excessive weakness
  • increased blood pressure

Some versions of cyclosporine can’t be used at the same time or after other psoriasis treatments. Tell your doctor about every drug or treatment you’ve ever taken and are currently taking. This includes medications to treat psoriasis as well as treatments for other conditions. If you have trouble remembering, which many people do, ask others who have helped manage your medications.

Your doctor will check your blood pressure before and during your treatment with this drug. You’ll likely also need to give regular urine tests. This is so your doctor can check for possible kidney damage.

This medication raises your risk of infections. You should avoid being around sick people so you don’t pick up their germs. Wash your hands often. If you have signs of an infection, call your doctor right away.

This drug can also cause nervous system problems. Tell your doctor immediately if you have any of these symptoms:

  • mental changes
  • muscle weakness
  • vision changes
  • dizziness
  • a loss of consciousness
  • seizures
  • yellowing of your skin or the whites of your eyes
  • blood in urine

Option #3: Methotrexate

Methotrexate belongs to a drug class called antimetabolites. It’s often marketed as Rheumatrex and Trexall. This drug is given to people with severe psoriasis who have not had much success with other treatments. It can slow the growth of skin cells and stop scales from forming.

The most common side effects include:

  • tiredness
  • chills
  • fever
  • nausea
  • stomach pain
  • dizziness
  • hair loss
  • eye redness
  • headaches
  • tender gums
  • loss of appetite
  • infections

This medication can cause serious, life-threatening side effects. You shouldn’t combine this drug with certain other drugs due to the risk of serious side effects. These may include anti-inflammatory drugs that are available over the counter. Talk to your doctor about other serious interactions associated with use.

If this drug is taken for a long time, it can cause liver damage. You shouldn’t take it if you have liver damage or a history of alcohol abuse or alcoholic liver disease.

Women who are pregnant, breast-feeding, or planning to become pregnant shouldn’t use this drug. Men should not get a woman pregnant during treatment and for three months after stopping this drug. Men should use condoms during this time.

Tell your doctor right away if you have any of these symptoms:

  • unusual bleeding
  • yellowing of your skin or whites of your eyes
  • dark-colored urine or blood in your urine
  • dry cough that doesn’t produce phlegm

Option #4: Apremilast

In 2014, the U.S. Food and Drug Administration (FDA) approved apremilast (Otezla) to treat psoriasis and psoriatic arthritis in adults. Apremilast is a small molecule treatment. It’s thought to work within your immune system and decrease your body’s response to inflammation.

According to the FDA, the most common side effects people experienced during clinical trials included:

  • headache
  • nausea
  • diarrhea

People who were taking this drug also reported depression more frequently during clinical trials than people taking a placebo.

Talk to your doctor before taking this drug if you have kidney disease. You may need a different dosage.

Apremilast can also cause unexplained weight loss. Your doctor should monitor your weight to check for unexplained weight loss during treatment.

How else is psoriasis treated?

Systemic treatments also include injected prescription drugs. As with their oral counterparts, injected drugs work throughout your entire body to slow the disease’s progress.

Biologics

Some injected drugs alter the immune system. These are known as biologics. Biologics are approved for treating moderate to severe psoriasis. They’re typically used when your body hasn’t responded to traditional therapy or in people who also experience psoriatic arthritis.

Possible biologics include:

Light therapy

This treatment involves controlled exposure to natural or artificial ultraviolet light. This can be done alone or in combination with other medications.

Potential therapies include:

  • UVB phototherapy
  • narrowband UVB therapy
  • psoralen plus ultraviolet A (PUVA) therapy
  • excimer laser therapy

Topical treatments

These are applied directly to your skin. Topical treatments generally work best on mild to moderate psoriasis. In more severe cases, topical treatments may be combined with oral medication or light therapy.

Common topical treatments include:

  • moisturizers
  • salicylic acid
  • coal tar
  • corticosteroid ointment
  • vitamin D analogues
  • retinoids
  • anthralin (Dritho-Scalp)
  • calcineurin inhibitors, such as tacrolimus (Prograf) and pimecrolimus (Elidel)

Learn more: Psoriasis treatment »

The bottom line

If you have psoriasis, discuss your treatment options with your doctor. As the disease progresses, you may need to change your treatment. You may need stronger treatments if the psoriasis becomes more severe or doesn’t respond. In these cases, oral medications may be a good option.

Psoriasis treatment is different for every person. You’ll likely have to change your treatment plan throughout your lifetime. New and better treatment options are on the horizon. Before you start taking these drugs, talk with your doctor about your options. It’s important to know how these medications may affect you. Work with your doctor to find the treatments that help relieve your symptoms without causing unpleasant side effects.

Keep reading: Why your psoriasis treatment isn’t working »

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