The American Academy of Dermatology has released new guidelines for treating psoriasis with traditional systemic therapies consisting of three commonly used FDA-approved systemic agents: methotrexate, cyclosporine and acitretin. These drugs are easily administered orally and are less expensive than bio-logics.
This is the Academy’s fourth of six sections of the guidelines of care for psoriasis. Three previously published sections focused on general recommendations for treating psoriasis and psoriatic arthritis and for using biologics and topical therapies.
Methotrexate is often effective even in severe cases, although it can cause nausea, fatigue, anorexia, and inflammation of the oral mucous membranes. White blood cell and platelet deficiency, liver damage, and lung scarring, birth defects, and miscarriage are also associated with this agent.
When cyclosporine is used for three to five years, scarring of the kidney’s blood vessels may develop. In the U.S., the new guidelines limit the use of cyclosporine to one year.
Acitretin, an oral retinoid, is derived from vitamin A. Retinoids inhibit excessive cell growth and stimulate differentiation of the epidermis. Etretinate, the first retinoid introduced for the treatment of severe psoriasis, was replaced in 1988 by acitretin, the active metabolite of etretinate. Used alone, acitretin is the least effective of the traditional systemic therapies; it is often used along with ultraviolet light. Potential effects include alopecia, nausea, abdominal pain, and joint and muscle pain. It can also cause birth defects; therefore, its use is limited to men and women of non-childbearing age.
The decision to prescribe these treatments or any other traditional therapy must be tailored to each patient.
Source: J Am Acad Dermatol online, June 4, 2009