What are the medications for psoriasis?

From the Guidelines

Treatment for psoriasis includes topical corticosteroids, vitamin D analogs, and retinoids for mild cases, while moderate to severe cases may require systemic medications such as methotrexate, biologics like adalimumab, or oral apremilast. According to the most recent guidelines, published in 2020 by the Journal of the American Academy of Dermatology 1, topical therapies may be effective for limited disease, but phototherapy or systemic treatments are often necessary to achieve and maintain skin clearance.

For systemic treatments, methotrexate is a commonly prescribed option, with guidelines for its dosing and monitoring published by the National Psoriasis Foundation, as noted in a 2009 study 1. Methotrexate can be dramatically effective, even in severe cases of psoriasis, and has been used in combination with biologic agents. Other systemic options include cyclosporine, which is effective but has limitations due to potential long-term toxicity, and biologics like adalimumab, which target specific molecular steps in the pathogenesis of psoriasis.

Key considerations in treating psoriasis include:

• Topical corticosteroids, such as betamethasone 0.05% cream, applied twice daily
• Vitamin D analogs, like calcipotriene 0.005% ointment, applied once daily
• Retinoids, such as tazarotene 0.1% gel, applied once daily
• Systemic medications, including methotrexate, starting at 7.5-15mg weekly, biologics like adalimumab, 40mg every other week, or oral apremilast, 30mg twice daily after titration
• Proper skin moisturization and avoiding triggers like stress and alcohol are important complementary measures, as noted in a 2005 study by the British Journal of Dermatology 1.

It is essential to consult a healthcare provider for proper diagnosis and personalized treatment recommendations, as the treatment duration and approach may vary based on the individual's response and the severity of their psoriasis.

From the FDA Drug Label

Methotrexate is indicated in the symptomatic control of severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy, but only when the diagnosis has been established, as by a biopsy and/or after dermatologic consultation Enbrel is indicated for the treatment of patients 4 years or older with chronic moderate to severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy.

The medications for psoriasis are:

• Methotrexate: for severe, recalcitrant, disabling psoriasis
• Etanercept (Enbrel): for chronic moderate to severe plaque psoriasis 2

From the Research

Medications for Psoriasis

The following medications are used to treat psoriasis:

• Topical therapies:
  • Corticosteroids 3, 4, 5, 6, 7
  • Calcipotriene, a vitamin D analogue 3, 4, 5, 7
  • Tazarotene, a retinoid 3, 4, 5
  • Anthralin 3, 5
• Phototherapy:
  • Broadband ultraviolet B (UVB) 4, 5
  • Narrowband UVB 4, 5
  • PUVA (psoralen and ultraviolet A) 4, 5
  • Climatotherapy 4
• Systemic therapies:
  • Acitretin 3
  • Methotrexate 3, 4
  • Cyclosporine 3, 4
  • Hydroxyurea 3
  • Thioguanine 3
  • Biologics 7

Combination Therapies

Combination therapies, such as using topical agents with biologics, conventional systemic agents, and phototherapy, have been shown to provide clinical benefits 7. Some examples of combination therapies include:

• Topical vitamin D analogs and corticosteroids 7
• Topical corticosteroids and phototherapy 5
• Systemic therapies and phototherapy 3, 4