Psoriasis is a common skin condition marked by patches of red, dry, and itchy skin with silvery scales. The best medications for psoriasis are oral and injected drugs. These can work in tandem with topical creams and light therapy to reduce inflammation.
In the early stages of psoriasis, doctors may prescribe topical medication that a person applies directly to the areas of skin that psoriasis is affecting.
If a person’s psoriasis does not improve with topical treatment, doctors may prescribe oral medication or injections that work throughout the body.
Two types of systemic medication are available: biological medications, which contain living immune system cells, and non-biological medications, which contain synthetic ingredients.
This article discusses the different types of psoriasis medication, their side effects and precautions, and how a person can prevent psoriasis flare-ups.
The table below offers an overview of the medications included in this article.
|Generic name||Brand name||Type||Form||Indications||Precautions|
• oral solution
|severe psoriasis||Use birth control during treatment and for 3 months after treatment.|
|severe psoriasis||not suitable for people with high blood pressure, cancer, or a weak immune system|
|acitretin||Soriatane||non-biological||capsule||severe psoriasis||Use birth control before and during treatment, then for 3 years after treatment ends.|
|apremilast||Otezla||non-biological||tablet||moderate to severe psoriasis||not suitable for those who are pregnant or nursing|
|dimethyl fumarate||Tecfidera||non-biological||tablet||off-label for psoriasis||• not suitable for pregnant people |
• interacts with alcohol and flu vaccine
|etanercept||Enbrel||biological||injection||chronic plaque psoriasis||not suitable for people with current or historical tuberculosis infection, shingles, hepatitis B, or hepatitis C|
|adalimumab||Humira||biological||injection||chronic plaque psoriasis||not safe alongside live vaccines|
|infliximab||Remicade||biological||injection||plaque psoriasis||not suitable for people with heart failure or current sepsis or tuberculosis infection|
|ustekinumab||Stelara||biological||injection||moderate to severe plaque psoriasis||• not suitable for people with current tuberculosis infection|
• may not be safe for people who have a latex allergy or are over age 60
There are many biological and non-biological medications for psoriasis that come in different forms and strengths.
Below are five non-biological medications to treat psoriasis.
Methotrexate helps ease severe psoriasis by reducing the growth of new skin cells. This can stop scaly patches from developing. It is available as a tablet, oral solution, or injection.
A person will take methotrexate once per week to treat psoriasis, and a doctor may suggest that a person start on a low dose and increase it gradually if necessary.
A person must not take too much methotrexate, as it can cause serious, life threatening side effects and death.
Methotrexate has several serious health warnings stating that the drug can:
- cause liver damage, particularly with long-term use
- cause lung damage
- cause damage to the mouth, stomach, and intestinal linings
- increase the risk of lymphoma
- decrease immune system activity
- cause harm or death to a developing fetus
Learn more about the health warnings for injectable methotrexate.
A person should use birth control while taking methotrexate and continue to use it for 3 months after stopping treatment. People who menstruate should continue to use birth control until they have had one period after stopping treatment.
Learn more about methotrexate and pregnancy.
Cyclosporine suppresses the immune system. Doctors prescribe it to
Cyclosporine is a pill that a person takes every day. The American Academy of Dermatology Association (AAD) reports that, in clinical trials, 80–90% of people who took cyclosporine for 12–16 weeks showed fast improvement.
Doctors generally prescribe cyclosporine for adults but will closely monitor children with severe psoriasis if they
Taking cyclosporine for only short periods can decrease the chance of serious side effects, which can include:
- kidney damage
- high blood pressure
- increased risk of squamous cell carcinoma
Learn more about cyclosporine.
Acitretin is an oral retinoid that comes as a capsule a person will take daily with their main meal. Doctors may prescribe it in combination with cyclosporine.
People can see improvements within
However, acitretin can cause side effects, which may include:
- brittle nails
- hair loss
- excessive sweating
- dry, peeling, and itchy skin
- dry nose and lips
It can also interact with progestin-only birth control pills. People who are pregnant or wish to become pregnant within 3 years should not take acitretin, as it can harm a developing fetus.
People who can become pregnant should use two forms of birth control for 2 months before they start taking acitretin and continue to do so while taking the medication and for 3 years after they stop taking it.
A person will take a low dose of apremilast at first and gradually increase the dose over 5 days. Doses will typically start at 10 milligrams (mg) per day and increase to 30 mg twice per day.
Possible side effects include:
Doctors typically prescribe dimethyl fumarate to treat multiple sclerosis (MS). Doctors can also use it off-label to treat plaque psoriasis, meaning that this use can be effective but the FDA
Dimethyl fumarate is an anti-inflammatory medication. A
Side effects can include:
- warm, red skin
- stomach pain
- itchy skin
Below are four biological medications for psoriasis.
Etanercept is an
This medication works by blocking the effects of an inflammatory protein that has elevated levels in psoriasis.
A person will inject this medication themself, usually into their thigh, lower abdomen, or upper arm. The typical dosage is 50 mg twice per week for 3 months, followed by 50 mg once per week.
Common side effects include upper respiratory tract infections and skin reactions at the injection site. This medication may not be suitable for older people, people who have a compromised immune system, or people who have a history of recurrent infections.
Adalimumab is an injectable medication that blocks a protein called tumor necrosis factor (TNF), reducing immune system activity and plaque formation. A person must be eligible for light therapy to use adalimumab.
A person will inject this medication into their thigh or lower abdomen. For psoriasis, a person will typically receive 1 initial dose of 80 mg followed by 40 mg every other week.
A person should not inject the medication into areas where they currently have psoriasis plaques.
Common side effects include reactions at the injection site, headaches, rash, and a risk of serious infection. It may also trigger tuberculosis in people who have had tuberculosis before.
Infliximab is FDA-approved to treat chronic, severe psoriasis in adults. It blocks TNF-alpha and therefore
A doctor will give a person infliximab via an intravenous (IV) line, meaning that the medication will flow directly into the person’s bloodstream.
Possible side effects include increased risk of infections, headache, nausea, and reactions caused by administering the medication into the veins.
Ustekinumab works by blocking the action of proteins IL-12 and IL-23, which play a role in psoriasis. This can reduce inflammation and immune responses.
It is an injection that a doctor can administer via an IV or into the skin. Administering medication into the skin is called a subcutaneous injection.
Doctors base a person’s dose of ustekinumab on their weight. If a person weighs 100 kilograms (kg) or less, they will have an initial 45-mg dose followed by a second dose 4 weeks later. They will then have an injection every 12 weeks.
If they weigh more than 100 kg, a person will have an initial dose of 90 mg and a second dose 4 weeks later. They will then have an injection every 12 weeks.
Side effects include swelling in the nasal passages and the back of the throat (nasopharyngitis), headache, fatigue, and sinusitis.
Other biological agents
The following medications are other biological injections:
Doctors prescribe these medications for moderate to severe psoriasis that has not responded to other treatments.
Other treatments for psoriasis include:
- Topical treatments: These are typically the first type of treatment a doctor will prescribe. In some cases, a person can get these medications without a prescription. Emollients, steroid creams and ointments, vitamin D analogues, coal tar, calcineurin inhibitors, and dithranol are types of topical treatments.
- Light therapy: Also called phototherapy, this treatment involves exposure to ultraviolet light and can slow down skin cell production. It may involve natural or artificial light. A person will see a dermatologist for light therapy. During certain light therapy sessions, doctors may give people with severe psoriasis a medication that makes their skin more sensitive to sunlight.
To manage psoriasis flare-ups, the AAD recommends that a person be aware of the following psoriasis triggers.
Stress is a common psoriasis trigger. Some people find stress management techniques, such as breathing exercises, yoga, and meditation, to be helpful for managing stress. A person can use these techniques even when their stress levels are low.
A person can develop a flare-up 10–14 days after a skin injury or bug bite. Cuts, scrapes, sunburn, bruises, and poison ivy can all trigger psoriasis. People should treat skin injuries quickly, avoid scratching irritated skin, and use insect repellent to help prevent bug bites.
The AAD notes that drinking alcohol daily or consuming more than two drinks per day can block the effects of psoriasis treatments. This can cause continual flare-ups.
The AAD recommends that females consume no more than one drink per day and that males consume no more than two. It can be dangerous to drink alcohol while taking certain psoriasis medications, so a person who typically drinks alcohol should consult a doctor before starting treatment.
Whether hot or cold, dry weather can affect psoriasis.
Using air conditioning in hot weather can dry out the skin. A person should regularly apply moisturizer to counteract this effect. They should also protect their skin from sunburn by applying sunscreen of SPF 30 or more to skin that is free of psoriasis and not covered by clothing.
In cold weather, a person can use humidifiers to add moisture to dry air, use moisturizers, keep showers and baths short, and use only warm water, not hot water, when bathing.
The AAD notes that if a person’s psoriasis does not improve with their usual treatment and other lifestyle changes to adapt to cold weather, a person should consult a dermatologist about light therapy.
Some psoriasis medications can cause flare-ups within the first 2–3 weeks of treatment. People should continue to take their medication during this period and stay in contact with their doctor to discuss any changes they can make.
A person should ask a doctor if any other medications they are currently taking or plan to take will cause psoriasis flare-ups.
A person with psoriasis should have regular checkups to monitor their condition. This way, a person can act quickly if their psoriasis worsens and get advice if they have concerns about living with the condition.
Most psoriasis medications can cause side effects. Some of these can be mild, and others can be life threatening.
During psoriasis flares, a person should contact a doctor if they experience symptoms of an infection, such as:
- pain, swelling, redness, or warmth of the skin
- red streaks on the skin
A person should seek immediate medical attention if they experience:
- severe reactions to medication
- symptoms of psoriatic arthritis, such as joint swelling
- symptoms of anxiety or depression
Psoriasis is a chronic autoimmune condition that can be lifelong in some people. The condition currently has no cure.
While psoriasis does not affect a person’s life expectancy, it can increase the risk of some serious health conditions, such as cardiovascular disease.
For instance, a
A person can lower their overall risk of cardiovascular disease by eating a balanced diet and exercising regularly.
A wide range of treatments is available for psoriasis, including topical medications, oral anti-inflammatories, and injections.
Doctors may prescribe oral or injectable medication if a person has severe psoriasis that has not responded to milder treatment.
A person should work closely with a dermatologist to decide which treatment is safe for them to take, as some treatments can cause serious side effects and increase a person’s risk of infection.