Psoriasis Drug Therapy

Our Specialty Pharmacy offers pharmacy services to people with psoriasis who need long-term etanercept (Enbrel), alefacept (Amevive) or other biologic drug therapy. Our pharmacy staff can provide the medications you need for your condition after you return home from the clinic. Experienced pharmacy professionals work closely with your Mayo Clinic care team to develop a personalized medication management program for you at no additional cost. We coordinate all billing and claims on your behalf, relieving you of up-front costs and the headaches of completing insurance forms and filing claims.

About Psoriasis
The Role of Medications in Treating Psoriasis
Side Effects, Cautions and Special Requirements
Always Ask Your Pharmacist

About Psoriasis

Psoriasis is a common skin condition characterized by a rapid buildup of rough, dry, dead skin cells which form thick scales. The condition can be frustrating, causing unsightly patches of skin, discomfort and even pain. Normally, it takes about a month for new skin cells to move from the lowest layer of your skin, where they first form, to the outermost layer, where they die and scale off in flakes. In psoriasis, the life cycle of skin cells speeds up, resulting in a multitude of dead cells on the outermost layer of your skin.

Psoriasis is a persistent, chronic disease that tends to flare up periodically then go into remission. It usually remains active for years. It affects an estimated 5.5 million Americans. Psoriasis can occur at any age, but the onset is usually gradual and the diagnosis is commonly made between the ages of 15 and 35.

The Role of Medications in Treating Psoriasis

Treatment approaches for psoriasis include:
Creams and ointments. Calcipotriene (Dovonex) is an ointment available by prescription that contains a derivative of vitamin D. Calcipotriene controls the overproduction of skin cells. It is a useful treatment for mild to moderate psoriasis. Steroid creams, coal tar, anthralin and a topical form of retinoic acid are other topical treatments.

Oral medications. Retinoids are a group of drugs related to vitamin A. Retinoids reduce the proliferation of skin cells in cases of severe psoriasis. Other oral medications include methotrexate, an anticancer drug that blocks the growth of skin cells in psoriasis, and cyclosporine (Gengraf, Neoral), which suppresses your immune system. Though these drugs are effective in treating severe psoriasis, they may also cause side effects, including liver and kidney toxicities.

Phototherapy. Psoralen plus ultraviolet A (PUVA), a combination of light-sensitizing medications (psoralens) and ultraviolet A light, is effective in suppressing the growth of skin cells in severe psoriasis. Exposure to moderate sunlight — being careful to avoid sunburn — as well as the topical application of coal tar combined with ultraviolet radiation is also an effective treatment. A form of phototherapy treatment called narrow-band ultraviolet B (UVB) has emerged in the past decade. This treatment may be as effective as PUVA but does not require that you take oral medications before each treatment. It is not thought to carry as high a potential for skin cancer as PUVA does.

Some doctors also give UVB treatment in conjunction with coal tar in the Goeckerman treatment. Combining the two approaches is more effective than using either alone. Doctors don't know exactly how the dual approach works, but using the coal tar seems to make the skin more receptive to the UVB light. Goeckerman treatment is available only at a few large medical centers in the United States, including Mayo Clinic. Doctors sometimes use phototherapy and oral medications in rotation to minimize side effects of both together.

Immune-modulating drugs (biologics). The Food and Drug Administration has approved several immune-modulating drugs for the treatment of moderate to severe cases of psoriasis. They include alefacept (Amevive), efalizumab (Raptiva) and etanercept (Enbrel). These drugs are given by intravenous infusion or intramuscular injection, and are usually reserved for patients who have failed to respond to traditional therapy or for people with associated arthritis.

Side Effects, Cautions and Special Requirements

Like all medications, those used for psoriasis may have side effects.
Topical treatments should be applied only as directed by your physician or pharmacist. Some should not be used on the face and others must be used only in a limited area. Calcipotriene (Dovonex) should not be used with products that contain salicylic acid (commonly found in over-the-counter psoriasis and acne medications) because acid breaks down its active ingredient.

Oral retinoids can cause severe birth defects and should not be taken during pregnancy. Retinoids also may cause eye and lip inflammation, bone spurs and hair loss.

Long-term use of PUVA — 250 treatments or more — may increase the risk of skin cancer and possibly melanoma, a deadly form of skin cancer. The higher risk begins about 15 years after the first PUVA treatment.

Immune-modulating drugs may cause headache, fever, chills, nausea and myalgia which happen most often after the first dose and then decrease with subsequent doses. Serious, and sometimes fatal, infections have also been reported with these drugs. Be sure to discuss the risks with your doctor.

Ask Your Pharmacist

If you experience problems with psoriasis treatment, your pharmacist is a reliable source of information about psoriasis management. Your pharmacist can help you monitor your condition, maximize the benefits of your medications, limit side effects and identify drug-drug or drug-disease interactions. Your pharmacist will work closely with your doctor to create a safe and appropriate care plan.

Optimal control of psoriasis requires the coordinated care of your health care team. Doctors, nurses and other caregivers must work closely with pharmacists and others to ensure therapy is safe and effective. Incomplete management of psoriasis or another medical condition may lead to complications or limit the success of treatment.