Other systemic medications
The following systemic medications are not approved by the FDA for the treatment of psoriasis. Some doctors are prescribing them "off-label" for psoriasis–a common and accepted medical practice.
Accutane
Accutane (also known by its generic name isotretinoin) is an oral retinoid that was approved as a treatment for severe cystic acne; however, some doctors have used it successfully to treat severe psoriasis. Generally, it is not as effective as Soriatane for psoriasis.
Accutane has many side effects similar to Soriatane. The most common side effects are eye and lip dryness, and nosebleeds. Bone spurs and hair loss occur to a lesser degree.
Accutane is cleared from the body much faster than Soriatane, and some doctors consider it a safer choice for young women of childbearing potential. However, it also has the potential for severe birth defects if a woman becomes pregnant while the drug is still in her system.
A woman on Accutane should use reliable birth control one month before treatment, during treatment and for at least one month afterward.
Hydrea
Hydrea (also known by its generic name hydroxyurea) is an oral cancer medication that in the 1960s was found to be effective for psoriasis. Although not as effective as methotrexate, it is less likely to cause liver damage with long-term use. It can produce significant improvement in stable plaque psoriasis, but it also has potentially dangerous side effects, including bone marrow toxicity. Long-term use has been associated with skin cancer.
Mycophenolate mofetil
Mycophenolate mofetil has been used for the prevention of organ transplant rejection, as well as in the treatment of several inflammatory or autoimmune skin diseases. It can be used in combination with cyclosporine, and some doctors use it when tapering patients off of cyclosporine. Because it is an immunosuppressive agent, people with compromised immune systems should not take it.
Sulfasalazine
Sulfasalazine is an oral medication reported to be effective for some people with psoriasis and psoriatic arthritis. It is significantly less effective than methotrexate. However, sulfasalazine tends to have less dangerous side effects. Therefore, trying this medication may be worthwhile for some. Many people cannot tolerate sulfasalazine because of allergy to sulfa, or because of side effects, including nausea, vomiting and loss of appetite.
6-Thioguanine
6-Thioguanine is an oral medication approved for treating certain types of leukemia. It has been reported to be effective for psoriasis in some cases, including treatment of pustular psoriasis. However, 6-Thioguanine must be used under close medical supervision due to the potential side effects associated with suppression of the bone marrow.
Updated January 2007
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