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Psoriasis Psoriasis Treatment
Side Effects of Psoriasis Treatments
Medically Reviewed On: December 15, 2005
Virtually all treatments have side effects, and treatments for psoriasis are no exception. That's why the best course of action is to use the lowest dose that's effective for the shortest time needed. The goal is to reduce side effects by reducing exposure to a particular treatment.
There are several approaches to treatment that can minimize side effects. One approach is to use a therapy until psoriasis clears and then follow a less-frequent maintenance regimen. Another is combination therapy, in which two or more treatments are used together to permit lower doses of each. Rotational therapy is a strategy in which patients switch from one treatment to another. Finally, sequential therapy involves using a specific combination of treatments in a deliberate sequence.
Below, you'll find the most common side effects of topical treatments, systemic agents (including biologic agents) and light treatments. Ask your doctor or pharmacist for a complete list of side effects, and bear in mind that just because a side effect is listed does not mean that you will experience that particular problem.
Topical Treatments
Topical treatments—meaning those that are applied to the skin—include corticosteroids, vitamin D compounds such as calcipotreine (Dovonex), retinoids such as tazarotene (Tazorac), coal tar, anthralin and salicylic acid.
- Corticosteroids: Possible side effects include skin atrophy, stretch marks and red spots. Rarely, heavy long-term use can cause a hormone imbalance.
- Calcipotriene: The main side effect is skin irritation, usually in the form of stinging or burning. Less-common side effects include dry skin, peeling, rash, dermatitis and worsening of psoriasis. Not recommended for use during pregnancy or breast-feeding.
- Tazarotene: May cause the skin to become irritated, red and burn more easily. Should not be used by women who are or may become pregnant.
- Coal tar: Can cause the skin to become irritated and red and can stain skin and clothing. Some of the chemicals in coal tar have been linked to cancer, but only when used in far higher concentrations than those used in topical medications.
- Anthralin: Can cause the skin to become irritated and can stain skin and clothing. It is unknown whether anthralin is safe during pregnancy.
- Salicylic acid: Can irritate the skin if left on for prolonged periods.
Systemic Agents
Systemic agents, which are taken in pill form, include the retinoid acritetin (Soriatane), methotrexate, cyclosporine and biologic agents.
- Acitretin: Possible side effects include hair loss, cracking of the lips, dry skin, gum bleeding, skin peeling, depression, headache, joint pain and high blood cholesterol. Should not be taken by pregnant women.
- Methotrexate: May cause nausea, fatigue, difficulty sleeping, lightheadedness, mouth ulcers, vomiting, headache, easy bruising and bleeding, fever, diarrhea and chills. Has the potential to damage to the liver and bone marrow with long-term use.
- Cyclosporine: Possible side effects include kidney damage, elevated blood pressure, headache, high cholesterol, excessive hair growth, tingling or burning sensations in the arms or legs, skin sensitivity, increased growth of gum tissue, flu-like symptoms, upset stomach, fatigue, and pain in muscles or joints.
- Biologic agents: Can increase the risk of infections, especially respiratory infections and have the potential to trigger a latent tuberculosis infection. May also produce flu-like symptoms and allergic reactions, usually where the medication is injected. Additional side effects depend on the agent used. The four biologic agents that have been approved for use in psoriasis or psoriatic arthritis are alefacept (Amevive), efalizumab (Raptiva), etanercept (Enbrel) and infliximab (Remicade).
Light Therapy
Light therapy includes treatments with ultraviolet A and B and laser treatments. Ultraviolet A can cause skin cancer, freckling, skin aging and cataracts. Ultraviolet B is less likely to cause skin cancer and other side effects. Excimer laser treatments can cause redness, blistering and the formation of shallow ulcers; there is a small risk of skin darkening or scarring. Pulsed dye lasers carry a small risk of scarring; the most common side effect is bruising.
Questions to ask your doctor:
1. What are the possible side effects of this treatment?
2. What should I do if I experience these side effects?
3. Will the side effects go away if I discontinue the treatment?
4. What can I do to minimize the risk of side effects?
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