Other Treatments
Oral (systemic) treatment of psoriasis may be used in severe cases. Several therapies are available, including acitretin (Soriatane®), an oral retinoid. This drug can be used alone or in combination with ultraviolet light therapy. Blood tests are performed regularly during treatment to monitor for side effects, which can include elevated levels of cholesterol and blood lipids (fats), and liver irritation. This drug is contraindicated in women who are pregnant and in those who intend to become pregnant within 3 years of discontinuing treatment.
Methotrexate, which inhibits cell proliferation, may be administered weekly to treat severe psoriasis and psoriatic arthritis. During treatment, daily supplementation with vitamins and 1 to 5 mg of folic acid is recommended to reduce the risk for anemia and nausea caused by the medication. Regular blood tests are also performed during treatment to detect liver inflammation. After 1–1.5 grams of the drug has been administered, a liver biopsy may be performed to detect abnormalities not apparent in blood tests.
Cyclosporine (Neoral®) also may be used to treat psoriasis. During this treatment, kidney function and cholesterol levels are monitored using blood tests.
Mycophenolate mofetil is an imunosuppressant that may be used. This medication is typically less effective than other drugs, but it is safe for long-term use. Maintaining a daily dosage under 3 grams minimizes side effects such as low white blood cell count (neutropenia). Routine blood tests are performed during treatment.
Alefacept (Amevive®) is an immunosuppressant used to treat moderate to severe psoriasis. This medication is given by injection or administered intravenously (through an IV) once a week, for 12 weeks. In some cases, the course is repeated.
Alefacept inhibits the production of overactive T cells, which can cause psoriasis, without impeding normal immune system function. T cell are a critical component of the immune system, and T cell counts are routinely monitored during the course of treatment.
Patients with compromised immune systems due to disease or medication and those undergoing phototherapy should not take alefacept. This medication should be used with caution in patients with a history of metastatic cancer or chronic infections.
Side effects include the following:
- Chills
- Cough
- Dizziness
- Headache
- Increased risk for infection and cancer
- Muscle pain
- Nausea
- Pain, itching, and inflammation (redness) at the injection site
- Sore throat
There are several ongoing investigations for biologic treatment of severe psoriasis. Initial trials with anti-CD 11a are promising. This medication, given by injection, modulates the immune system's activity, thus resolving psoriasis plaques.
Efalizumab (Raptiva®) is a once-weekly injection approved by the U.S. Food and Drug Administration (FDA) to treat moderate-to-severe psoriasis in people over the age of 18. This medication, which suppresses the immune system, may increase the risk for serious infections (e.g., bacterial sepsis, viral meningitis, fungal infection). Raptiva also may cause a life-threatening infection called progressive multifocal leukoencephalopathy (PML). Patients who are taking this drug and develop symptoms of PML (e.g., confusion, dizziness, loss of balance, vision loss, weakness, excessive bleeding or bruising) should seek immediate medical attention.
Adalimumab (Humira®) is another prescription medication approved to treat moderate to severe chronic plaque psoriasis in adults. This medicine, which is used in patients who are under the care of a physician, may be helpful for those who experience red, scaly skin over several areas of the body. Adalimumab affects the body's immune system and may cause serious infections, resulting from bacteria, viruses, or fungi.
At this time, not enough is known about psoriasis to prevent its occurrence. Patients who have experienced a psoriasis flare-up with strep throat should be treated using antibiotics at the first sign of infection.
For more information, contact the National Psoriasis Foundation at www.psoriasis.org.
Physician-developed and -monitored.
Original Date of Publication: 01 Sep 2000
Reviewed by: Stanley J. Swierzewski, III, M.D.
Last Reviewed: 04 Dec 2007
Psoriasis, Other Treatments, Prevention reprinted with permission from dermatologychannel.net
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