Oral medications for psoriasis: List and side effects

Psoriasis is an autoimmune disease causing skin to become red, itchy, scaly to sore. Some people treat it with topical medicines which directly apply to the skin. Nevertheless, if a person has moderate to severe psoriasis a doctor can prescribe oral medicines.

An estimated 25 percent of all psoriasis sufferers have moderate or severe psoriasis. Many of those people require phototherapy or oral medication.

The article provides an overview of the various types of oral medications, their uses and their possible side effects.

Hand holding a pill
Systemic psoriasis medications work all over the body to try to treat the underlying causes of the disease.

Oral psoriasis medicines are one form of systemic medicine. It means they operate throughout the body instead of just reacting to the psoriasis symptoms, trying to treat the underlying causes of psoriasis.

Psoriasis is an autoimmune disease which means that an individual’s immune system is overactive and attacks healthy cells in the skin. Systemic medicine is designed to stop it autoimmune response from occurring.

Although oral medicines are not a remedy, they are more effective at inducing psoriasis to go into remission than topical lotions. Remission is when an person has few symptoms or no.

According to the American Academy of Dermatology (AAD), some systemic medications for psoriasis include:

  • methotrexate
  • cyclosporine
  • apremilast

Another type of drug available in some European countries is the fumaric acid esters.

Methotrexate

Methotrexate reduces inflammation, which can relieve a person with psoriasis experiences swelling and itchiness. Methotrexate may also decrease joint pain related to psoriatic arthritis.

Usually, methotrexate improves symptoms of psoriasis in 20 to 30 percent of people. Possible Methotrexate side effects include:

  • nausea
  • hair loss
  • liver disease, although this is rare

A person should not take methotrexate if they:

  • regularly drink a lot of alcohol
  • have a liver or kidney disease
  • have a stomach ulcer

Methotrexate is not suitable for pregnant or breastfeeding women, either. People should avoid using it, too, if they want to conceive.

Cyclosporine

Cyclosporine works by inhibiting an immune system in a human. Cyclosporine is “one of the most effective and fast-acting medicines” for psoriasis, according to research done in 2013.

The AAD states that when taking cyclosporine, 80 to 90 percent of people see a rapid improvement in their psoriasis symptoms.

Anyone taking cyclosporine can experience the following side effects, according to the National Psoriasis Foundation (NPF),:

  • tingling skin, numbness, or pins and needles
  • headaches
  • joint pain
  • muscle twitching
  • increased hair growth
  • high blood pressure

Those who have kidney failure or cancer should avoid cyclosporine, just as those with high blood pressure and those who are pregnant or trying to get pregnant would.

Fumaric acid esters

Fumaric acid esters are another oral medication that has been shown to be a safe and effective way of treating psoriasis, according to the journal Psoriasis.

The United States Food and Drug Administration (FDA) has not approved fumaric acid esters as a psoriasis medication in America, although they are available in some European countries.

Possible side effects of esters of the fumaric acid include:

  • diarrhea
  • nausea
  • stomach ache
  • red and hot face

Individuals should not be taking esters of fumaric acid if they have problems with the stomach or intestines. Anyone who is pregnant or breastfeeding should also avoid taking them because of the lack of research.

Apremilast

Apremilast is a new type of treatment which may be prescribed by a doctor if other oral medicines do not work.

It is a targeted treatment which reduces the activity of an enzyme that causes inflammation in immune cells.

Clinical trials showed, according to the ADD, that after 16 weeks, 20 percent of people taking apremilast for plaque psoriasis found their symptoms had resolved or nearly cleared, and more than 40 percent of people with scalp psoriasis reported their symptoms improving or disappearing.

The ADD states that apremilast’s common side effects include:

  • diarrhea
  • nausea
  • headaches
  • chest infection
  • depression
  • weight loss

Alternative treatments

Biological medications, or biologics, may also treat psoriasis, depending on the symptom form and severity.

Biological medications are a very effective form of treatment, as about 70 percent of people see their symptoms of psoriasis improving.

Common side-effects for biologics according to the NPF include:

  • respiratory infections
  • flu-like symptoms
  • injection site reactions

Rarer side effects include:

  • nervous system disorders
  • blood disorders
  • cancers

Biologics are not suitable for people who have or have had:

  • kidney or liver failure
  • cancer
  • multiple sclerosis, or a family member who has it
  • hepatitis
  • tuberculosis
  • heart failure
  • serious infection

When to see a doctor

Although oral psoriasis medication may cause more side-effects than topical medications, it may also be more effective in inducing a person’s psoriasis to go into remission.

If someone who takes some form of medication is having adverse side effects, they should talk to their doctor. A doctor may prescribe ways of reducing or managing side effects, or may change the type of medicine that a person is taking.

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