Systemics

Systemic medications are prescription medications that affect the entire body. They are generally reserved for people with moderate to severe psoriasis or psoriatic arthritis, or psoriasis that affects the hands, feet or nails. A dermatologist will consider systemic medications if your psoriasis has failed to respond to various topical treatments, and UV therapy, or if you are unable to use these treatments.

All of the systemic treatments that are available to treat psoriasis and psoriatic arthritis are associated with significant short- and long-term side effects. The benefits of psoriasis clearance or improvement must be balanced against the risk of these side effects. The four most commonly prescribed systemic medications to treat psoriasis are Methotrexate, Ciclosporin, Acitretin and Hydroxycarbamide.
Methotrexate, Ciclosporin and Hydroxycarbamide all work by suppressing the immune system, whereas Acitretin is a Vitamin A derived treatment.

The following is a brief overview of the four main systemic treatments. For more detailed information, please contact us.

Methotrexate
Methotrexate works by slowing down the production of skin cells.
Most patients find that their psoriasis clears significantly in four to eight weeks.
Methotrexate is usually taken orally once a week.

Side effects
Feelings of nausea are experienced by up to a quarter of all patients treated.
Liver damage can also occur so it is important not to drink alcohol and to have checks to make sure your liver is functioning effectively.
Anaemia, excessive bleeding and being prone to infections are rare side effects of taking methotrexate.

Prior to and whilst taking Methotrexate
Tell your dermatologist what other treatments that you are taking as they may have a negative interaction with methotrexate.
Conception must be prevented whilst using this drug and for the following six months (this applies to men and women). Breast-feeding must also be avoided.

Ciclosporin
Ciclosporin works by slowing down the production of skin cells.
Most patients find that they see an improvement in their psoriasis after three to four weeks.
Treatment with ciclosporin is usually for short periods – up to one year.
Ciclosporin is not usually prescribed for children under 16 or the elderly.

Side effects
Side effects include nausea, abdominal pain, diarrhoea and headaches.
Kidney damage can also occur as can hypertension, so blood and blood pressure tests are required.
If you are allergic to ciclosporin you may experience an itchy rash, swelling of the face, lips or tongue, faintness or wheezing / trouble breathing. If you experience any of these symptoms tell your doctor, dermatologist or pharmacist as soon as possible.

Prior to and whilst taking Ciclosporin
Before using ciclosporin women should be up to date with their cervical smears and blood tests should be taken. These levels should then be reviewed regularly.
You should tell your dermatologist all other treatments that you are taking whether prescribed, over the counter or complementary, as they could interact with the ciclosporin.
Do not eat grapefruit or drink grapefruit juice for one hour prior to taking your ciclosporin as it may impair the absorption of the drug into your blood stream.

Acitretin
Acitretin works by slowing down the rapid production of skin cells and allows shedding to produce normal skin.
Acitretin belongs to the retinoid family of drugs, which are derived from vitamin A.
This drug is taken in the form of a capsule, once a day with a meal or glass of milk.
You may also know this treatment as Neotigason.

Side effects
Acitretin has many side effects, however they are usually temporary and wear off as treatment continues.
Side effects include dry lips, eyes and face – all of which are relieved by moisturisers. Nosebleeds can also be a side effect of Acitretin treatment.
Further side effects may include hair loss, muscle aches and pains, headaches.

Prior to and whilst taking Acitretin.
Pregnancy must be unequivocally avoided whilst on acitretin and also for two years following the end of the treatment. Breast-feeding whilst taking this drug may also be harmful to the baby. It is safe for men using this drug to start a family.
Your dermatologist may combine this treatment with PUVA therapy as this combination has been seen to be effective, resulting in a reduction in the dose of UVA needed to achieve clearance.
You cannot give blood whilst on acitretin or for one year after ending the treatment.
Do not take vitamin A supplements.

Hydroxycarbamide
Hydroxycarbamide works by slowing down the production of new cells.
It is taken orally, either once or twice a day.
Hydroxyurea has fewer side effects than the other systemic drugs mentioned here.

Side effects
Unwanted side effects that Hydroxycarbamide may cause include a reduction of the blood count, which can result in anaemia and bleeding, bone marrow suppression, hair loss, leg ulcers and gout.

Prior to and whilst taking Hydroxycarbamide
A full blood test will be required before commencing treatment, followed by weekly blood tests, which will gradually become less frequent.
Pregnancy must be avoided whilst on hydroxycarbamide and also for two months following therapy. Men must also avoid starting a family whilst on this drug.