1. Systemic
treatment for
Psoriasis
Nick Harper

3. Topical treatment
• Calcipotriol (Dovonex)
• Eumovate/Betnovate
• Dovobet
• Coal tar
• Dithranol
• Tazarotene (Zorac)
• Salicylic acid

5. Systemic treatment
Methotrexate
Retinoids
Ciclosporin

6. 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

7. Ciclosporin
• Immunosuppressant
(organ transplants)
• 2.5-5mg/kg
• Usually max 8 weeks
• Control/flares
Nephrotoxic
Hypertension
Skin cancer
Lymphoma
BP
Renal function
Serum creatinine

8. Retinoids
• Acitretin
• 25-50mg OD PO
• Pustular psoriasis
• Re-PUVA
Teratogenicity (3 years)
Cracked lips
Itching
Peeling skin
Hyperostosis

9. Which to choose?
• NICE & Cochrane still pending
Drug
PASI
75
Indication Main SE Check UV Notes
Methotrexat
e
60%
Severe
psoriasis
Hepatotoxic
FBC
Renal fx
Liver fx
Avoid
Teratogeni
c
(1 month)
Ciclosporin 70%
Severe
psoriasis
Nephrotoxi
c
BP
Renal fx
Avoid Cancer risk
Acitretin 30%
Pustular
psoriasis
Cracked lips
Peeling skin
-
RE-
PUVA
Teratogeni
c
(3 years)

10. Which to choose?
• NICE & Cochrane still pending
Drug
PASI
75
Indication Main SE Check UV Notes
Methotrexat
e
60%
Severe
psoriasis
Hepatotoxic
FBC
Renal fx
Liver fx
Avoid
Teratogeni
c
(1 month)
Ciclosporin 70%
Severe
psoriasis
Nephrotoxi
c
BP
Renal fx
Avoid Cancer risk
Acitretin 30%
Pustular
psoriasis
Cracked lips
Peeling skin
-
RE-
PUVA
Teratogeni
c
(3 years)