Oral systemic treatments are small molecule medicines that are taken by mouth. Systemic medications, aimed at those with moderate-to-severe psoriasis and psoriatic arthritis, are prescription drugs that work throughout the body. They are also used in those who are not responsive or are unable to take topical medications or UV light therapy.
Oral Treatments
Systemic psoriasis drugs have been around for more than 10 years and are taken by mouth in liquid or pill form or given by injection.
Newer oral systemic treatments selectively target molecules inside immune cells. By adjusting the complicated processes of inflammation within the cell, these treatments correct the overactive immune response that causes inflammation in those with psoriatic disease, leading to improvements in redness and a reduction in psoriasis scales, tenderness and swelling.
Some treatments, such as methotrexate, which is an oral systemic (see below), are also disease-modifying antirheumatic drugs (DMARDs). DMARDs may relieve more severe symptoms and attempt to slow or stop joint and tissue damage and the progression of psoriatic arthritis.
Types of Oral Treatments
Cyclosporine
Cyclosporine is an immunosuppressive drug that was first used to help prevent rejection in organ transplant patients. In 1997, the FDA approved Neoral (a trade name for cyclosporine) for adults with severe psoriasis and otherwise normal immune systems. Cyclosporine suppresses the immune system and slows down the growth of certain immune cells.
Methotrexate
Methotrexate was initially used to treat cancer. It was approved by the FDA in the 1970s for the treatment of severe psoriasis. In a person with psoriasis, methotrexate binds to and inhibits an enzyme involved in the rapid growth of skin cells and slows their growth rate.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs), including over-the-counter medications such as aspirin and ibuprofen as well as prescription products, help to decrease inflammation, joint pain and stiffness. Aspirin can help reduce pain, swelling and stiffness.
Off-Label Systemics
There are additional systemic medications that are not approved by the FDA for treating psoriasis and psoriatic arthritis. However, some doctors prescribe them “off-label” — a common and accepted medical practice.
Otezla (apremilast)
Otezla treats psoriasis and psoriatic arthritis by regulating inflammation within the cell. Otezla inhibits an enzyme known as phosphodiesterase 4 (PDE4). This enzyme controls much of the inflammatory action within cells, which can affect the level of inflammation associated with psoriatic disease.
Rinvoq (upadacitinib)
Rinvoq works by targeting a specific part of the immune system (Janus kinase) to reduce the overactive immune response associated with psoriatic arthritis (PsA). Rinvoq is approved for the treatment of adults with active PsA who have had an inadequate response or intolerance to one or more tumor necrosis factor (TNF) inhibitors.
Soriatane (acitretin)
Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Acitretin is the only oral retinoid approved by the FDA specifically for treating psoriasis. The exact way Soriatane works to control psoriasis is unknown. In general, retinoids help control the multiplication of cells, including the speed at which skin cells grow and shed.
Sotyktu (deucravacitinib)
Sotyktu selectively targets the immune system by inhibiting tyrosine kinase 2 (TYK2), a member of the Janus kinase (JAK) family. Sotyktu is approved for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
Xeljanz and Xeljanz XR (tofacitinib)
Aimed at reducing psoriatic arthritis inflammation, Xeljanz targets a specific part of the immune system (Janus kinase) to reduce the overactive response associated with psoriatic disease. The oral treatment also aids in reducing joint tenderness and swelling.
Understanding Your Prescription
Labeling for prescription medicines is required for all FDA-approved prescription medicines, but what does it all mean?
Help is Here for You
NPF Patient Navigatiors can answer your questions about oral treatments, including understanding their side effects and helping assess potential risks.
Last updated on 03/25/25 by the National Psoriasis Foundation.