Topical Medications
Corticosteroids
Amcinonide (Cyclocort® and generics), betamethasone dipropionate (Diprosone®, Diprolene®, and generics), betamethasone valerate (Betaderm®, Valisone®, and generics), clobetasol propionate (Dermovate® and generics), desoximetasone (Topicort® and generics), hydrocortisone (Emo Cort® and generics), and prednicarbate (Dermatop®)
Decreases inflammation, redness, and itchiness by modifying cell processes and other immune system components.
Vitamin A derivatives
Tazarotene (Tazorac®)
Slows down skill cell growth and reduces inflammation.
Vitamin D derivatives
Calcipotriol (Dovonex®), calcitriol (Silkis®), calcipotriol with betamethasone (Dovobet®)
Controls abnormal growth of cells to flatten lesions and reduce scales.
Anthracene derivatives
Anthralin
Slows down growth of skin cells that causes psoriasis lesions and reduces inflammation
Salicylic acid
Salicylic acid with coal tar (Targel SA®, salicylic acid with corticosteroid (Diprosalic®)
Peels the outer layer of skin to soften and remove psoriasis scales.
Coal tar
Targel®
Slows growth of skin cells and reduces inflammation, itching, and scaling.
Corticosteroids
Amcinonide (Cyclocort® and generics), betamethasone dipropionate (Diprosone®, Diprolene®, and generics), betamethasone valerate (Betaderm®, Valisone®, and generics), clobetasol propionate (Dermovate® and generics), desoximetasone (Topicort® and generics), hydrocortisone (Emo Cort® and generics), and prednicarbate (Dermatop®)
Apply to psoriasis lesions once to twice per day.
Less-potent steroid are used for thin-skinned or more sensitive areas (face, skin folds, groin, breasts).
More potent steroids are used for thicker skin over a short term (palms of hands, soles of feet).
Vitamin A derivatives
Tazarotene (Tazorac®)
Apply once per day to affected area. Avoid sensitive areas (face, skin folds, groin, breasts).
Vitamin D derivatives
Calcipotriol (Dovonex®), calcitriol (Silkis®), calcipotriol with betamethasone (Dovobet®)
Apply twice a day to affected area if used alone. Avoid sensitive areas (face, skin folds).
Apply once a day at a different time of day if used together with a topical steroid.
Devobet®: apply once a day to affected area. Avoid sensitive areas (face, skin folds).
Anthracene derivatives
Anthralin
Apply once a day. Avoid sensitive areas (skin folds, groin).
Salicylic acid
Salicylic acid with coal tar (Targel SA®, salicylic acid with corticosteroid (Diprosalic®)
Apply once or twice a day to the body or twice a week to the scalp.
Coal tar
Targel®
Apply once a day to affected area, except skin folds.
Corticosteroids
Amcinonide (Cyclocort® and generics), betamethasone dipropionate (Diprosone®, Diprolene®, and generics), betamethasone valerate (Betaderm®, Valisone®, and generics), clobetasol propionate (Dermovate® and generics), desoximetasone (Topicort® and generics), hydrocortisone (Emo Cort® and generics), and prednicarbate (Dermatop®)
- Redness, dryness, irritation, itching, burning, thinning of the skin, bruising, dilation of blood vessels close to the skin surface, changes in pigmentation, excessive hair growth, skin infection, and stretch marks
- Rosacea (an inflammatory skin condition) or tiny red bumps around the mouth, if topical corticosteroids are applied to the face
Vitamin A derivatives
Tazarotene (Tazorac®)
- Itching, redness, burning, or rash; skin irritation, pain, or stinging sensation; worsening of psoriasis, skin peeling, dry skin, skin swelling
- Increased sun sensitivity
Vitamin D derivatives
Calcipotriol (Dovonex®), calcitriol (Silkis®), calcipotriol with betamethasone (Dovobet®)
- Irritation or discomfort, and itching of the skin
- Increased risk of skin infection
- Combination products may cause both vitamin D derivative side effects and topical corticosteroid side effects
Anthracene derivatives
Anthralin
- Skin irritation, especially to the normal skin surrounding lesions
- Can also stain hair, skin, clothing, and bedding. Stained hair and skin will eventually fade
Salicylic acid
Salicylic acid with coal tar (Targel SA®, salicylic acid with corticosteroid (Diprosalic®)
- Skin drying, itching, redness, peeling, and stinging
- Long-term use over large areas of the body may cause absorption of salicylic acid, especially in children
- Combination products may cause side effects from the different medications that make up the combination (e.g., topical corticosteroid side effects and salicylic acid side effects for Diprosalic®)
Coal tar
Targel®
- Sensitivity to sunlight
- Skin irritation, redness, dryness, and hair follicle inflammation
- Coal tar also has an odour and can stain hair, skin, clothing, and bedding
Oral Treatments
Cytotoxic agents
Methotrexate
Blocks an enzyme required for proper growth of cells and thus reduces rapid overgrowth of skin cells
Immunosuppressants
Cyclosporine (Neoral® and generics)
Decreases activity of immune system to reduce skin cell overgrowth
Phosphodiesterase 4 inhibitor
Apremilast (Otezla®)
Blocks phosphodiesterase 4, which is involved in making the immune system overactive, causing psoriasis
Retinoids
Acitretin (Soriatane®)
Reduces speed of skin cell growth
Cytotoxic agents
Methotrexate
Take once per week; sometimes used in conjunction with folic acid.
Immunosuppressants
Cyclosporine (Neoral® and generics)
Take twice a day.
Phosphodiesterase 4 inhibitor
Apremilast (Otezla®)
Take twice a day.
Retinoids
Acitretin (Soriatane®)
Take once daily with food.
Cytotoxic agents
Methotrexate
- Nausea, vomiting, upset stomach
- Stomach pain
- Loss of appetite
- Dizziness
- Fever and chills
- Diarrhea
- Sores on mouth or lips
- Tiredness
- Decreased white blood cell count (which could lead to a decreased ability to fight infection)
- Liver toxicity
- Sore throat and swelling of glands
Immunosuppressants
Cyclosporine (Neoral® and generics)
- High blood pressure
- Increased levels of lipids (e.g., cholesterol) in the blood
- Kidney or liver problems
- Slight trembling of the hands
- Headache (including migraine)
- Night sweats
- Hearing loss
- Swelling of the face
- Muscle pain, joint pain
- Upset stomach
- Tingling sensations in the fingers, toes, or mouth
- Loss of appetite; nausea
- Vomiting
- Diarrhea or constipation
- Increased growth of fine hairs on the body
- Acne or oily skin
- Anxiety
- Increased potassium in the body
- Swollen or tender gums
- Low level of white blood cells
- High level of sugar in the blood
- Hot flushes
- Rash
- Decreased ability to fight infection
Phosphodiesterase 4 inhibitor
Apremilast (Otezla®)
- Diarrhea
- Nausea
- Vomiting
- Headache
- Upper respiratory tract infection (e.g., common cold)
- Flu (body aches and pains, tiredness, fever)
- Decreased appetite
- Abdominal discomfort, indigestion
- Fatigue, trouble sleeping
- Back pain
- Dizziness
Retinoids
Acitretin (Soriatane®)
- Chills, joint pain, and increased sensitivity to touch
- Hair loss
- Dry lips and mouth
- Skin problems (e.g., excessive sweating, sensitivity to light)
- Peeling skin (fingertips, palms, soles)
- Thinning of the skin
- Nosebleeds
- Runny or dry nose
- Nail disorder
- Ear problems (e.g., pain, wax build-up)
- Eye problems (e.g., dry eyes, blurred vision)
- Inflammation of the eyelids
- Tiredness, pain, thirst
- Swelling of leg, foot, ankle
- Bleeding or inflammation of the gums and inside of the mouth
- Nausea and abdominal pain
- Altered appetite
- Back, bone, or muscle pain
- Headache, trouble sleeping
- Can cause birth defects, so pregnant women or women planning to become pregnant should not take this medication
Injectable Treatments
Interleukin-12 and interleukin-23 inhibitors
Ustekinumab (Stelara®)
Blocks interleukin-12 and interleukin-23, which are involved in making the immune system overactive, causing psoriasis
Interleukin-17A inhibitor
Secukinumab (Cosentyx®)
Blocks interleukin-17A, which is involved in making the immune system overactive, causing psoriasis
TNF-alpha blocker
Infliximab (Remicade®), etanercept (Enbrel®), adalimumab (Humira®)
Blocks tumour necrosis factor (TNF) alpha, which is involved in causing inflammation.
Cytotoxics
Methotrexate
Blocks an enzyme required for proper growth of cells and thus reduces rapid overgrowth of skin cells.
Interleukin-12 and interleukin-23 inhibitors
Ustekinumab (Stelara®)
Subcutaneous injection* on weeks 0 and 4, and then every 12 weeks thereafter
Interleukin-17A inhibitor
Secukinumab (Cosentyx®)
Subcutaneous injection (under the skin) on weeks 0, 1, 2, 3, 4, and then every 4 weeks thereafter
TNF-alpha blocker
Infliximab (Remicade®), etanercept (Enbrel®), adalimumab (Humira®)
Infliximab:
2-hour intravenous infusion on weeks 0, 2, and 6, and then every 8 weeks thereafter
Etanercept:
Subcutaneous injection twice a week for first 3 months, then once or twice per week thereafter.
Adalimumab:
Subcutaneous injection every 2 weeks.
Cytotoxics
Methotrexate
Subcutaneous injection (under the skin) once per week; sometimes used in conjunction with folic acid
Interleukin-12 and interleukin-23 inhibitors
Ustekinumab (Stelara®)
- Allergic reaction (signs may include a skin rash; swollen face, lips, mouth, or throat; wheezing; dizziness; trouble swallowing or breathing)
- As the drug modifies the immune system, it decreases the body's ability to fight infections, leading to an increased risk of infection, including upper respiratory tract infections (e.g., sore throat, sinus infection), tuberculosis and systemic fungal, viral, and bacterial infections
- Headache
- Increased risk of cancer
- Increased risk of serious skin conditions (increase in redness and shedding of skin)
Interleukin-17A inhibitor
Secukinumab (Cosentyx®)
- Allergic reaction (signs may include skin rash; swollen face, lips, mouth, or throat; wheezing; dizziness; trouble swallowing or breathing)
- As the drug modifies the immune system, it decreases the body's ability to fight infections, leading to an increased risk of infection, including upper respiratory tract infections (e.g., sore throat, sinus infection), tuberculosis and systemic fungal, viral, and bacterial infections
- Runny nose
- Diarrhea
TNF-alpha blocker
Infliximab (Remicade®), etanercept (Enbrel®), adalimumab (Humira®)
- Shortness of breath
- Rash
- Headache
- Abdominal and back pain
- Cough
- Diarrhea
- Dizziness
- Fatigue
- Itchiness
- Injection site reaction (e.g., redness, bruising)
- Pain
- Upset stomach, nausea
- Nervous system disorders (e.g., multiple sclerosis, seizures)
- Allergic reaction (signs may include a skin rash; swollen face, lips, mouth, or throat; wheezing; dizziness; trouble swallowing or breathing)
- As these drugs modify the immune system, they decrease the body's ability to fight infections, leading to an increased risk of serious systemic fungal, viral, and bacterial infections (e.g., tuberculosis, sepsis), upper respiratory tract infections (e.g., sore throat, bronchitis, sinus infection), and urinary tract infections
- Flu-like symptoms
- Reactions to the intravenous infusion (e.g., hives, difficulty breathing, chest pain)
- Increased risk of cancer
Cytotoxics
Methotrexate
- Nausea, vomiting, upset stomach
- Stomach pain
- Loss of appetite
- Dizziness
- Fever and chills
- Diarrhea
- Sores on mouth or lips
- Tiredness
- Liver toxicity
- Decreased white blood cell count (which could lead to a decreased ability to fight infection)
- Sore throat, and swelling of glands
Light therapy
PUVA
Psoralen plus ultraviolet A light
Psoralen is a topical medication that makes skin more sensitive to light
Skin is exposed to UVA light to slow down the overgrowth of skin cells to reduce lesions
UVB
Ultraviolet B light
UVB light slows down fast overgrowth of skin cells on the outermost layers of skin
PUVA
Psoralen plus ultraviolet A light
Used 1 to 4 times a week at a doctor's office
UVB
Ultraviolet B light
Used 1 to 5 times a week at a doctor's office.
PUVA
Psoralen plus ultraviolet A light
- Increased sensitivity to sunlight
- Nausea
- Itching
- Skin redness
- Blistering
- Skin aging
- Freckling
- Increased risk of non-melanoma skin cancer because of UVA exposure, so doctors (usually dermatologists) must supervise and advise on the amount of PUVA therapy
UVB