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Systemic treatment for
PsoriasisNick Harper
Topical treatment
• Calcipotriol (Dovonex)
• Eumovate/Betnovate
• Dovobet
• Coal tar
• Dithranol
• Tazarotene (Zorac)
• Salicylic acid
Systemic treatment
Methotrexate
Retinoids
Ciclosporin
Methotrexate
• Folic acid antagonist• Anti-inflammatory & immune
modulator• Once a week 7.5-15mg PO
•Liver toxicity–Nausea, vomiting–Abdo discomfort–Dark urine
•Blood dyscrasia–Sore throat–Bruising–Mouth ulcers
–Teratogenicity – 3 months
• FBC• Renal function• liver function
Ciclosporin• Immunosuppressant (organ transplants)• 2.5-5mg/kg• Usually max 8 weeks• Control/flares
Nephrotoxic
Hypertension
Skin cancer
Lymphoma
BP
Renal function
Serum creatinine
Retinoids• Acitretin• 25-50mg OD PO• Pustular psoriasis• Re-PUVA
Teratogenicity (3 years)
Cracked lips
Itching
Peeling skin
Hyperostosis
Which to choose?• NICE & Cochrane still pending
Drug PASI 75 Indication Main SE Check UV Notes
Methotrexate 60% Severe
psoriasis HepatotoxicFBC
Renal fxLiver fx
AvoidTeratogeni
c(1 month)
Ciclosporin 70% Severe psoriasis
Nephrotoxic
BPRenal fx Avoid Cancer risk
Acitretin 30% Pustular psoriasis
Cracked lipsPeeling skin - RE-
PUVA
Teratogenic
(3 years)
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