Systemic Drugs for Psoriasis

Reviewed by: HU Medical Review Board | Last reviewed: December 2023

Psoriasis is an autoimmune condition that causes inflammation in the body. This inflammation triggers new skin cells to grow at a faster rate than older skin cells are shed.1

The extra skin cells build up and form areas called plaques. Plaques are silver in color, scaly, and can cover large or small areas of the body. The symptoms may be mild to severe.1

Psoriasis is a long-term (chronic) condition with many treatment options, such as topical medications, phototherapy, and systemic drugs.1

How do systemic drugs work?

Systemic drugs are powerful medicines that affect the whole body, not just the skin. Since these treatments can have significant side effects, they are usually prescribed for people with moderate-to-severe psoriasis who cannot control their symptoms with other treatments.2

Systemic drugs work by changing how immune cells work and reduce the immune response that causes inflammation. This, in turn, reduces redness, psoriasis scales, sensitive skin, and swelling. These drugs may also slow or stop joint and tissue damage.2

Types of systemic drugs for psoriasis

Systemic drugs may be given by mouth, injection, or infusion. There are 2 types of systemics: traditional, and biologics or biosimilars.

Traditional systemic drugs

Examples of traditional systemic drugs include:1,2

Biologic and biosimilar systemic drugs

Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. The process of making biologics turns products made from cells into drugs that can prevent, treat, and cure disease. These are different from most traditional drugs. Traditional drugs are made from chemicals in a lab. Their ingredients are not directly derived from living cells. Drugs similar in structure to biologic drugs are called biosimilars.3,4

Examples of biologics and biosimilars used to treat psoriasis include:1,5-17

  • Adalimumab
  • Avsola®, Inflectra® (infliximab)
  • Cimzia® (certolizumab pegol)
  • Cosentyx® (secukinumab)
  • Enbrel® (etanercept)
  • Ilyuma® (tildrakizumab)
  • Otezla® (apremilast)
  • Rinvoq® (upadacitinib)
  • Siliq® (brodalumab)
  • Skyrizi® (risankizumab)
  • SotyktuTM (deucravacitinib)
  • Stelara® (ustekinumab)
  • Taltz® (ixekizumab)
  • Tremfya® (guselkumab)
  • Xeljanz® (tofacitinib)

Off-label systemic drugs

There are also systemic drugs used off-label to treat psoriasis. Off-label means the US Food and Drug Administration has not approved the drug to treat psoriasis but some doctors may prescribe them anyway. This is a common practice.18

Examples of off-label systemic drugs used for psoriasis include:18

  • Hydrea (hydroxyurea)
  • Isotretinoin
  • Mycophenolate mofetil
  • Sulfasalazine
  • 6-Thioguanine

What are the possible side effects?

Systemic psoriasis drugs are a large group, and side effects vary widely depending on the specific drug you are taking. A few of the more common side effects are:1,5-17

  • Stuffy nose
  • Coughing
  • Sinus or ear infections
  • Nausea or diarrhea
  • Headache
  • Fatigue
  • Greater risk of infection
  • Weight loss
  • Hair loss
  • Increased risk of depression
  • Pain
  • Anemia
  • Skin reactions at the injection site

Many systemic drugs should not be taken while you are pregnant, trying to become pregnant, pregnant, or breastfeeding. Talk to your doctor about what is right for you.1,5-17

These are not all the possible side effects of systemic drugs for psoriasis. Talk to your doctor about what to expect when taking a systemic drug. You also should call your doctor if you have any changes that concern you when taking one of these drugs.

Other things to know

Some systemic drugs may not be right for people with high blood pressure, diabetes, cancer, or liver or kidney conditions.1,5-17

Before beginning treatment for psoriasis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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