"The good news is that psoriasis is manageable, manageable now to the point that for the majority of patients we can completely clear the skin of all skin lesions and do so fairly safely. Just a few years ago, we didn't have such great options," says Steven Feldman, MD, PhD, professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, N.C. "Treatments are now more effective, safer and easier to use than ever."
One of the main advantages of oral medications is how long the drugs have been around. "Most doctors are going to start you off with the medication that has the fewest side effects and the least chance of causing harm,” says Kathy Kavlick, RN, community outreach nurse for the Murdough Family Center for Psoriasis in Cleveland. In comparison to some of the newer psoriasis drugs on the market, Kavlick says, "these systemics have been around a lot longer, so we know a lot more about their long-term effects and what to watch for."
If your psoriasis causes significant discomfort or pain or covers a sizable part of your body, your dermatologist is likely to discuss the possibility of using a systemic. Some insurance companies also require psoriasis patients to try an oral medication before starting a biologic, since biologics are far more expensive. The primary oral medications prescribed for psoriasis are methotrexate, cyclosporine, and acitretin.
Heres what you should know about the different systemic medications:
What it is: Methotrexate belongs to a class of drugs known as antimetabolites, and it works by interfering with the overproduction of skin cells that causes psoriatic plaques to develop. Methotrexate is usually taken once a week in a single dose of up to 30 mg, although it is sometimes broken up into three smaller doses spread out over a 24-hour period.
Efficacy: Studies have shown that methotrexate is effective in 70% to 80% of psoriasis patients. In a 2003 study of oral medications published in the New England Journal of Medicine, 60% of the patients who received methotrexate experienced partial remission; of those patients, 65% saw near-complete remission. Patients usually start to see results after two to three months.
Side effects: The most common side effect is nausea, which is usually alleviated by supplementing the drug with folic acid. Other side effects are more serious. Liver damage is a primary concern with methotrexate, especially for people who drink alcohol or who are diabetic or obese. (The risk of liver damage is high enough that, after taking the drug for a year or more, patients often require a liver biopsy to test for toxins in the organ.) Methotrexate can also cause birth defects and cannot be used during pregnancy.