The best medications for psoriasis will depend on the individual. Many people benefit from topical medication, but stronger options include oral drugs, injections, or other treatments, such as light therapy.
Doctors may start by recommending topical medication that a person applies only to the affected areas of skin. If this is not sufficient, they may suggest treatments that work throughout the body.
Two types of systemic medication are available: biological medications, which contain living immune system cells, and nonbiological medications, which contain synthetic ingredients.
This article discusses the different types of psoriasis medication, their side effects and precautions, and how a person can prevent psoriasis flare-ups.
The table below offers an overview of the nonbiological medications doctors for psoriasis:
| Generic name | Brand names | Forms | Indications | Precautions |
|---|---|---|---|---|
| methotrexate | • Trexall • Rasuvo • Otrexup | • tablet • oral solution • injection | severe psoriasis | Use birth control during treatment and for at least 6 months after. |
| cyclosporine | • Neoral • Deximune • Capimune | • liquid • capsule | severe psoriasis | |
| acitretin | Soriatane | capsule | severe psoriasis | Use birth control before and during treatment, then for 3 years after treatment ends. |
| apremilast | Otezla | tablet | moderate to severe psoriasis | |
| dimethyl fumarate | Tecfidera | tablet | off-label for psoriasis | • not suitable for pregnant people • interacts with alcohol and flu vaccine |
In the following table are some of the biological medications. All of these drugs are unsuitable for people:
- with current, recurring, or chronic infections
- who have recently received live vaccines or are due to receive one
- who are pregnant or nursing, or plan to become pregnant in the near future
Additional precautions are listed below:
| Generic name | Brand names | Form | Indications | Precautions |
|---|---|---|---|---|
| enteracept | Enbrel | injection | chronic plaque psoriasis | |
| adalimumab | Humira | injection | chronic plaque psoriasis | • not suitable for people with demyelinating neurological conditions, such as multiple sclerosis • may not be suitable for people with heart failure or a history of cancer |
| infliximab | Remicade | injection | plaque psoriasis | |
| ustekinumab | Stelara | injection | moderate to severe plaque psoriasis | may not be safe for people who have a latex allergy or are |
| guselkumab | Tremfya | injection | plaque psoriasis | • may interact with certain medications, such as warfarin and cyclosporine • people should not become pregnant for at least 12 weeks after treatment stops |
| brodalumab | Siliq | injection | moderate to severe plaque psoriasis | |
| secukinumab | Cosentyx | injection | moderate to severe plaque psoriasis | • may worsen Crohn’s disease • may be unsafe for people with a latex allergy • people should not become pregnant for at least 20 weeks after treatment stops |
| ixekizumab | Taltz | injection | plaque psoriasis | • may worsen Crohn’s disease and ulcerative colitis • people should not become pregnant for at least 10 weeks after treatment stops |
| risankizumab | Skyrizi | injection | moderate to severe plaque psoriasis | People should not become pregnant for at least 21 weeks after treatment stops. |
| tildrakizumab | Ilumya | injection | moderate to severe plaque psoriasis | not suitable for people who have had a previous hypersensitivity reaction |
Because many of these drugs affect the whole immune system, all of the above also carry a risk for severe infections.
Below are five nonbiological medications to treat psoriasis.
Methotrexate
Methotrexate helps to ease severe psoriasis by reducing the growth of new skin cells. This can stop scaly patches from developing. It is available as a tablet, oral solution, or injection.
A person will take methotrexate once per week to treat psoriasis. A doctor may suggest that a person start on a low dose and increase it gradually if necessary.
A person must not take too much methotrexate, as it can cause serious, life threatening side effects and death.
Methotrexate has several serious health warnings stating that the drug can:
- cause liver damage, particularly with long-term use
- cause lung damage
- cause damage to the mouth, stomach, and intestinal linings
- increase the risk of lymphoma
- decrease immune system activity
- cause harm or death to a developing fetus
A person should use birth control while taking methotrexate and not get pregnant for at least 6 months after stopping treatment.
Cyclosporine
Cyclosporine suppresses the immune system. Doctors prescribe it to
Cyclosporine is a pill that people take every day. The American Academy of Dermatology Association (AAD) reports that, in clinical trials, 80% to 90% of people who took cyclosporine for 12 to 16 weeks showed fast improvement.
Doctors generally prescribe cyclosporine for adults, but will closely monitor children with severe psoriasis if they
Taking cyclosporine for only short periods can decrease the chance of serious side effects, which can include:
- kidney damage
- high blood pressure
- increased risk of squamous cell carcinoma
Acitretin
Acitretin is an oral retinoid that comes as a capsule a person will take daily with their main meal. Doctors may prescribe it in combination with cyclosporine.
Acitretin may regulate the immune system and have anti-inflammatory effects. People can often see improvements within
However, acitretin can cause side effects, which may include:
- brittle nails
- hair loss
- excessive sweating
- dandruff
- dry, peeling, and itchy skin
- dry nose and lips
It can also interact with progestin-only birth control pills. People who are pregnant or wish to become pregnant within 3 years should not take acitretin, as it can harm a developing fetus.
People who can become pregnant should use two forms of birth control for 2 months before they start taking acitretin and continue to do so while taking the medication and for 3 years after they stop taking it.
Apremilast
Apremilast is
A person will take a low dose of apremilast at first and gradually increase the dose over 5 days. Doses will typically start at 10 milligrams (mg) per day and increase to 30 mg twice per day.
Possible side effects include:
Dimethyl fumarate
Dimethyl fumarate is an anti-inflammatory medication. Doctors typically prescribe it to treat multiple sclerosis (MS), but they can also use it off-label to treat plaque psoriasis.
Side effects can include:
- warm skin
- stomach pain
- diarrhea
- nausea
- itchy skin
Below are four biological medications for psoriasis.
Etanercept
Etanercept is an
This medication works by blocking the effects of an inflammatory protein that has elevated levels in psoriasis.
A person will inject this medication themself, usually into their thigh, lower abdomen, or upper arm. The typical dosage is 50 mg twice per week for 3 months, followed by 50 mg once per week.
Common side effects include upper respiratory tract infections and skin reactions at the injection site. This medication may not be suitable for older people, people who have a compromised immune system, or people who have a history of recurrent infections.
Adalimumab
Adalimumab is an injectable medication that blocks a protein called tumor necrosis factor (TNF), reducing immune system activity and plaque formation. A person must be eligible for light therapy to use adalimumab.
A person will inject this medication into their thigh or lower abdomen. For psoriasis, a person will typically receive
A person should not inject the medication into areas where they currently have psoriasis plaques.
Common side effects include reactions at the injection site, headaches, rash, and a risk of serious infection. It may also trigger tuberculosis in people who have had tuberculosis before.
Infliximab
Infliximab is FDA approved to treat chronic, severe psoriasis in adults. It blocks TNF-alpha and therefore
A doctor will give a person infliximab via an IV line, meaning the medication will flow directly into the person’s bloodstream.
Possible side effects include increased risk of infections, headache, nausea, and reactions caused by administering the medication into the veins.
Ustekinumab
Ustekinumab works by blocking the action of proteins IL-12 and IL-23, which play a role in psoriasis. It is an injection that a doctor can administer via an IV or into the skin.
Doctors base a person’s dose of ustekinumab on their weight. If a person weighs 100 kilograms (kg) or less, they will have an initial 45 mg dose followed by a second dose 4 weeks later. They will then have an injection every 12 weeks.
If they weigh more than 100 kg, a person will have an initial dose of 90 mg and a second dose 4 weeks later. They will then have an injection every 12 weeks.
Side effects include swelling in the nasal passages and the back of the throat (nasopharyngitis), headache, fatigue, and sinusitis.
Newer biological agents
Some newer biological injections that doctors may suggest include:
Doctors may prescribe these medications for moderate to severe psoriasis that has not responded to other treatments.
Other treatments for psoriasis include:
- Topical treatments: These are typically the first type of treatment a doctor will prescribe. They include steroidal and nonsteroidal creams, vitamin D analogues, vitamin A derivatives, and anthralin.
- Light therapy: Also called phototherapy, this treatment involves exposure to ultraviolet light and can slow down skin cell production. It may involve natural or artificial light. A person will see a dermatologist for light therapy. During certain light therapy sessions, doctors may give people with severe psoriasis a medication that makes their skin more sensitive to sunlight.
Preventing flare-ups by avoiding triggers is also part of psoriasis management.
A person with psoriasis should have regular checkups to monitor their condition and how their treatment is going.
Most psoriasis medications can cause side effects or have a risk of complications. Some of these can be mild, and others can be life-threatening. Report any mild side effects to a doctor.
For severe side effects, seek immediate help. This could include:
- signs of a skin infection, such as pus, swelling, warmth, or streaks on the skin
- signs of an infection elsewhere, such as fatigue, headaches, body aches, fever, or chills
- signs of meningitis, such as a stiff neck, aversion to light, nausea, or a skin rash
- mood changes, depression, or suicidal thoughts
- signs of a serious allergic reaction, such as swelling in the mouth or throat and difficulty breathing
If a person becomes pregnant while taking psoriasis medication or in the weeks after stopping treatment, they should tell a doctor immediately.
The following are frequently asked questions about psoriasis medications.
Finding the best medication or treatment for psoriasis can be complicated. Most people apply topical medications directly to the skin, but some need stronger treatments.
A person can work with a doctor to find the best treatment plan that works for them.
Common anti-inflammatory medications for psoriasis include topical steroids and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or COX-2 inhibitors. A doctor may prescribe stronger medications if these are not working.
How quickly people respond to psoriasis treatments depends on the individual and their situation. Some treatments may work within weeks, while others may need months.
A wide range of treatments is available for psoriasis, including topical medications, oral anti-inflammatories, and injections.
Doctors may prescribe oral or injectable medication if a person has severe psoriasis that has not responded to milder treatment.
A person should work closely with a dermatologist to decide which treatment is safe for them to take, as some treatments can cause serious side effects and increase a person’s risk of infection.