A guide to oral medications for psoriasis

Treating moderate-to-severe psoriasis often requires systemic therapies, or medications that work by reducing inflammation throughout the body. Some systemic therapies, called biologic therapies, are given with injections or infusions. Several other treatment options are taken as oral medications.

Below is a look at the different types of oral medications that are available, as well as emerging therapies that are taken as oral medications.

When is psoriasis moderate-to-severe?

While there are no true universal guidelines for categorizing psoriasis severity, there are factors that are consistently used in assessments. One is the total body surface area (BSA) that is affected by psoriasis.

• Less than 3 percent is mild
• 3 to 10 percent is moderate
• More than 10 percent is severe

However, the impact on a person’s quality of life and functioning is equally important, and often more important, than body surface area. Small amounts of psoriasis that affect the face, hands, genitals, or other highly visible or highly sensitive areas of the body can be considered moderate to severe because they often cause high amounts of distress, physical discomfort, and limit functioning.

The National Psoriasis Foundation has begun categorizing severity based on what treatments are required to manage psoriasis. With this method, psoriasis that can be managed with topical therapies alone is considered mild, and psoriasis that requires systemic therapies is considered moderate-to-severe. It’s common for treatment to include a combination of topical and systemic therapies.

Oral systemic therapies for psoriasis

There are multiple types of oral medications used to treat moderate-to-severe psoriasis. Some have been around for decades. Others have been around for a decade or less. And there are also emerging therapies that are in clinical trials or beginning to become available.

Traditional systemic medications

These are the oral medications that have been used in psoriasis treatment for decades. This list includes immunosuppressants and a type of drug called an oral retinoid.

• Immunosuppressants. As the name implies, these medications suppress the immune system. Suppressing the immune system helps reduce inflammation throughout the body but also reduces the body’s ability to fight infections.
• Oral retinoid. Retinoids are compounds derived from vitamin A or synthetic versions of vitamin A. These drugs can help control the rate at which cells multiply. The oral retinoid that is used to treat psoriasis reduces inflammation and skin cell division. This may be used in combination with phototherapy.

These medications are often affordable but also have limitations. Immunosuppressants require regular monitoring for blood cell counts, liver function, kidney function, and pregnancy. Treatment with an oral retinoid requires a person to avoid pregnancy and breastfeeding for at least three years after discontinuing treatment.

Targeted treatments

Newer oral medications are sometimes called targeted therapies because they target specific proteins in the inflammatory pathways that underlie psoriasis symptoms. An inflammatory pathway is a series of chemical reactions that regulates the activation of immune cells and the release of inflammatory chemicals.

Targeted therapies include:

• Oral small molecule drugs. These are drug compounds that can easily enter cells and mimic the behavior of natural substances. Examples include drugs called TYK2 inhibitors and PDE4 inhibitors. These drugs are not typically as effective as biologics but are still an excellent treatment option for many people, with a lower risk of side effects and cost.
• Targeted oral peptides. These are a new and emerging therapy. Peptides are compounds that are larger than small molecules but smaller than proteins. Peptide therapies are known to be effective at blocking protein-protein interactions (like the kind that occur in an inflammatory pathway). The goal is to develop oral medications that can achieve treatment outcomes close or equal to biologics.

Talk to your healthcare provider

It’s important to remember that there is no best treatment for psoriasis. Different treatments work for different people. Treatment can also change over time, and it’s common to switch from one medication to another. Talk to your healthcare provider about any questions

For questions about psoriasis treatment, your best source of information will be your healthcare provider.