Psoriasis Oral and Injection Medication Print
A final category of medications is the oral prescriptions, used mainly for patients with severe flare-ups.   Some of these medications may be injected, and others may have severe side effects.  These are typically used only for brief periods of time, and a physician will continue to attempt to use the methods above for new flare ups, as they are less invasive to the general health of the patient.  Let us consider several of the more common oral or injected medications for psoriasis, their effectiveness, and their possible side effects.

The first group of oral medications is the retinoids, which are derivatives of vitamin A.  Though it can be used topically without a great deal of caution, when used orally it can and does cause severe birth defects.   So much so that women who have taken oral retinoids need to avoid becoming pregnant for at least three years after discontinuing the medication.  However, for patients whose psoriasis does not respond to other treatment, this may be an option.  One problem is that the improvement noticed during the treatment typically stops once the medication is stopped, and symptoms often return.   

The oral medication methotrexate may be a significant help in those people who have psoriatic arthritis.   This drug reduces psoriasis symptoms by decreasing the reproduction of skin cells, by suppressing inflammation, and by reducing the release of histamine.  Histamine is the chemical a person’s body produces when irritated, and is known by many people as an allergic reaction. Methotrexate may also slow the progression of joint problems in psoriatic arthritis. It is generally well tolerated by most people when given in low doses.   Long term side effects of methotrexate can include severe liver damage, and a reduction in the production of red and white blood cells and platelets. Using one milligram of folic acid as a vitamin supplement every day may help reduce some of the common side effects associated with methotrexate.

A different drug that works about as well as methotrexate is known as cyclosporine.  It is effective because it suppresses the immune system of the patient.  Like other drugs that affect the immune system, cyclosporine increases the risk of infection while taking it, and has additional negative health consequences, including an increased risk of cancer. Cyclosporine also makes a patient more susceptible to kidney problems and also increases the probability of high blood pressure.  The risks for cyclosporine increase with higher prescribed dosages, or when taking the medication for a prolonged time.

An oral medication that is not as generally effective as the previous two medications is hydroxyurea.   However, this is the only one of the three that can be used in combination with a light therapy treatment.   Again there are possible side effects, and these include anemia and a decrease in white blood cells and platelets. It should be avoided by women who are pregnant or planning to become pregnant.  Please advise the physician accordingly.

One of the strongest drugs to treat inflammations due to psoriasis is azathioprine.  This drug is very potent and controls inflammations quite well.   It has short-term side effects of fatigue, bruising easily, possible nausea and vomiting.  If taken for a long time, there are increased risk of developing growths (either cancerous or noncancerous), and a number of different blood disorders.  Azathioprine is usually only prescribed for patients with severe psoriasis inflammations that have not responded to other treatments.

There is a class of medicines known as biologics that work by blocking interactions between certain immune system cells. Although they're derived from natural sources rather than chemical ones, their effects on a person’s immune system are considerable, and they probably have many of the same risks as other immunosuppressant drugs.   The general names for those used in the treatment of psoriasis are immunomodulator drugs, and several are approved for the treatment of moderate to severe cases of psoriasis. They include alefacept (Amevive), efalizumab (Raptiva), etanercept (Enbrel) and infliximab (Remicade).  

These medications work in one of two ways.  Some block the activity of main cytokine involved in the activity of psoriasis. Others block the activity of a patient’s overactive T-cells.  These are not oral medications, but are given by intravenous infusion, intramuscular injection or subcutaneous injection.  These medications are also relatively new and extremely expensive. Since the side effects may be considerable, these choices are usually used for people who have failed to respond to traditional therapy, or for people with severe psoriatic arthritis.