Psoriasis treatments: systemic medicines: overview

Some people we talked to had tried systemic medicines for psoriasis after trying other treatments first, such as steroid creams. Systemic treatments are prescribed to people who have severe psoriasis covering a big portion of the body and if other treatments have not worked or if they stopped using them because of major side effects. Lisa asked her GP for systemic treatments when she was younger but she was told to try other options first because the medicines can have side effects and risks. Many people had heard that some systemic medicines are expensive to the NHS and saw this as a factor which might affect a doctor’s willingness to prescribe those particular options.

Systemic treatments for psoriasis affect the person’s whole body rather than just the part where topicals, like steroids, are applied. There are two types of systemic medicines which are swallowed as tablets or given as injections and drips:
  • non-biological systemic treatments, such as cyclosporine (also spelt ciclosporin), acitretin and methotrexate, which are usually taken as tablets
  • biological systemic treatments which are injected, sometimes with an injector pen at home, such as adalimumab (e.g. Humira), etanercept (e.g. Enbrel) and ustekinumab (e.g. Stelara). Infliximab is given through a drip in hospital.
Systemic treatments were seen by most people as “big” and “serious” medicines for psoriasis because they knew that they were used to treat other conditions such as cancer (chemotherapy treatment) and in organ transplants. For psoriasis, systemic drugs like methotrexate and cyclosporine are used to reduce inflammation. Steven’s keen to avoid systemic medicines “for as long as possible” and prefers trying other treatments (e.g. steroids, dithranol, phototherapy). Systemic treatments can be effective but can have serious side effects. Both cyclosporine and methotrexate can cause damage to organs (such as the kidneys and liver) and bone marrow, which is why people need regular blood tests to check for side effects. Methotrexate can cause fetal anomalies (birth defects) for both women who become/are pregnant and men who impregnate women whilst taking the treatment. Acitretin is not usually prescribed to women because it can continue to cause fetal anomalies up to three years after treatment has ended.


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