Systemic treatments are medicines that work on the whole body (or body systems). They are usually taken by mouth in tablet or capsule form. Common treatments are methotrexate, ciclosporin, fumaric acid esters and acitretin.

Biologic treatments and oral small molecule medicines may be used if systemic treatments don’t work well or side effects become a problem. They target overactive cells in the immune system that cause inflammation.

Systemics, biologics and oral small molecules for your skin can only be prescribed by a specialist skin doctor (dermatologist). Please talk to your doctor or healthcare provider about your treatment options.

Systemic treatments

Systemic treatments work by damping down the immune response that causes the inflammation of psoriasis or by reducing cell growth in the skin. They all work slightly differently therefore it is important to discuss the benefits and risks of the different options with your doctor.

Systemic treatments are processed in the body by the liver or kidneys. Other medicines such as painkillers, herbal supplements and some foods such as grapefruit as well as alcohol may interact with the medicine when taken together. It can cause the medication to work differently from how it should do or may upset the way the liver or kidneys function. This is why you may be asked if you drink alcohol or take any other medication or supplements by your doctor or healthcare provider.

If you find the medication doesn’t fit in with your lifestyle or you don’t like the way it makes you feel, discuss this with the doctor or healthcare provider. They may be able to suggest a different treatment for you to consider.

Oral small molecule treatments

Oral small molecules are medicines that are taken by mouth. They target molecules inside immune cells and correct the overactive immune response that causes inflammation in psoriasis. Oral small molecule treatments are used to treat moderate to severe psoriasis that has not responded to systemic treatments or when these treatments are not suitable or cause side effects.

Biologic treatments

Biologics target specific parts of the immune system that are overactive in psoriasis. They are used if you have moderate to severe psoriasis that has not responded to systemic treatments or if you cannot use other treatments. How often you take the biologic varies from every 2 weeks to once every 3 months depending on the biologic. They are usually given by injection, which can be given at home by yourself or, in the case of one biologic, in hospital through an infusion drip. There are a number of biologics available, and their availability differs widely from country to country; your doctor or healthcare provider will be able to discuss and select the most appropriate one for you.

It’s possible for a biologic to stop working after a person takes it for some time. Stopping and starting may cause a biologic to lose its effectiveness and cause certain side effects. If this happens, you might notice psoriasis plaques coming back and your doctor may recommend additional treatments or changing to another biologic.

Several biologics have biosimilars which are highly similar, almost exact replicas of the original biologic. This means you can expect the same safety and effectiveness over the course of treatment as you would the original biologic at a lower cost, depending on the availability in your country.

See Table 1 for currently available biologics and biosimilars.

Table 1

Biologics and biosimilars currently available for psoriasis*

*Availability varies from country to country