Which medications are used to treat psoriasis?

Updated: Mar 17, 2021
  • Author: Jacquiline Habashy, DO, MSc; Chief Editor: William D James, MD  more...
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Answer

Many drugs that affect the rate of skin cell production are used in psoriasis therapy alone or in combination with light therapy, stress reduction, and climatotherapy. Adjuncts to treatment include sunshine, moisturizers, and salicylic acid as a scale-removing agent. Generally, these therapies are used for patients with less than 20% of body surface area involved, unless the lesions are physically, socially, or economically disabling.

Treatments for more advanced psoriasis include narrowband ultraviolet B (UVB) light, psoralen with ultraviolet A (UVA) light retinoids (eg, isotretinoin [Accutane, Claravis], acitretin [Soriatane]), methotrexate (particularly for arthritis), cyclosporine (Neoral, Sandimmune), infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), apremilast (Otezla), and secukinumab (Cosentyx). Decreased effectiveness of infliximab or adalimumab in a patient previously well controlled on the medication may mean that antibodies to the medication are being produced. [63]

In a study of ustekinumab in patients with moderate-to-severe psoriasis, investigators did not observe an increased trend in dose-related or cumulative toxicity with the duration of ustekinumab treatment. The investigators also reported rates of adverse events generally comparable to those of other biologics approved for managing moderate-to-severe psoriasis. [2]  It is approved in two dosages, administered subcutaneously, with the higher dose given to those weighing 100 kg (220 pounds) or more. It has been suggested that 91 kg (200 pounds) might be a better cutoff for the higher dose for optimal control. [3]

Recommendations from a 2013 international consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis include methotrexate and cyclosporine, biologic agents, and combination therapy. [7]

The AAD guidelines recommend treatment with methotrexate, cyclosporine, and acitretin, with consideration of the contraindications and drug interactions noted in the discussion of each medication below. [6]

Many other medications are used off label for psoriasis. Many of these are drugs approved initially for rheumatoid arthritis or inflammatory bowel disease but are found to also have benefits in skin psoriasis. Tofacitinib citrate, a Janus kinase inhibitor, is such a medication that has shown promise in the treatment of psoriasis. [64] Caution must be taken any time a medication is used off label because the true risks and benefits may not yet have been defined for a different patient population than that originally studied.


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