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Oral Treatment

Methotrexate:

Methotrexate is usually given once a week orally (pills) at doses ranging from 2.5 to 25 mg. or occasionally by injection (with a needle). It can be administered either as a single dose or in a split dose twelve hours apart for three doses. It helps control psoriasis affecting your skin, nails, and joints. The mechanism of action is the interference with DNA synthesis repair and cellular replication. It has an immunomodulatory effect.

Twenty-six percent of patients achieve a PASI (Psoriasis Area and Severity Index) 75 response at twenty-four weeks. The onset is usually between four and six weeks.

Side effects include upset stomach, mouth ulcers and tiredness. Long-term risks include liver damage, birth defects, bone marrow toxicity and suppression of the bone marrow with low blood counts. Careful monitoring by your physician is essential on this medication. Liver biopsies may be required. It is contra-indicated in liver disease and alcoholism.

Acitretin (Soriatane):

Acitretin is a retinoid with properties similar to vitamin A. For most patients, it does not appear to be as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis. However, it works quite well for pustular psoriasis. It is used mainly in men, and women who are post-menopausal or have had a hysterectomy.It is not used in women of child bearing age because of the risks of birth defects. Monitoring by your doctor and regular blood tests are required while taking this medication.

The mechanism of action is unknown. It inhibits cell replication by modulating cellular differentiation within the epidermis.

It works slowly and the onset of response is usually two to four months. It is not as effective when used as monotherapy but can be combined with photo therapy as well as the new biologics. It is helpful particularly for palmar plantar psoriasis.

Side effects include dryness of the skin, lips, eyes, and nose. Elevation of the cholesterol and triglyceride levels liver toxicity and bone changes, since it may cause birth defects. Safety concerns include hyperlipidemia and alopecia. Depression and psychiatric symptoms such as aggressive behaviour and thoughts of suicide have been reported. It is usually administered daily at a dose of 10 or 25 mg. The frequency of taking this drug is often reduced to two or three times a week at least initially.

Cyclosporine (Neoral):

Cyclosporine is an immunosuppressant psoriasis medication used in organ transplantation. It is very effective, but because of its cost and side effects (kidney toxicity, high blood pressure, numbness and tingling, hair growth, skin cancer and lymphomas), it is usually reserved for people with severe, disabling, resistant disease. Monitoring required by your doctor while taking this medication includes blood pressure, creatinine and urea.

This acts on T-lymphocytes. It is specific and reversible inhibition of active T-lymphocytes.

About eighty percent of patients achieve a PASI (Psoriasis Area and Severity Index) 75 response at twelve weeks after discontinuing therapy. The disease usually returns within seven weeks. The rate of onset of response is quick and often is seen within four weeks.

It is usually administered once to twice a day orally.