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)