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American Academy of Dermatology Issues New Guidelines For the Management of Psoriasis With Systemic Medications
Date:6/4/2009

dosing of cyclosporine is given as 2.5 mg/kg to 5.0 mg/kg a day in two divided doses, and physicians should make decreased dose adjustments by 0.5 mg/kg to 1.0 mg/kg when psoriasis is cleared or when high blood pressure or decreased kidney function test results are observed.

Toxicities & Contraindications

The most serious side effects associated with cyclosporine are kidney damage and high blood pressure, which is why it requires careful patient selection and subsequent monitoring to be used safely. A number of drug interactions can occur with this medication, and the FDA advises that it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

"Studies also show that patients with psoriasis taking cyclosporine may be at increased risk of developing squamous cell carcinoma, particularly those with a history of more than 200 PUVA treatments," said Dr. Pariser. "Due to these known toxicities and contraindications, a careful assessment of a psoriasis patient's disease severity is critical when assessing the risk-benefit ratio of treatment with cyclosporine."

Acitretin

Acitretin is an oral retinoid, which is derived from vitamin A. Although the exact way retinoids work in the treatment of psoriasis is not completely understood, they are known to inhibit excessive cell growth and stimulate differentiation of the epidermis (outermost layer of the skin). Etretinate was the first retinoid introduced for the treatment of severe psoriasis and was replaced by acitretin, the active metabolite of etretinate, in 1988.

Efficacy & Dosage

Clinical studies suggest that when used alone, acitretin is the least effective of the traditional systemic therapies and is therefore often used in conjunction with ultraviolet (UV) light. The effectiveness of acitretin is dose dependent, with dosing ranging from 10 mg to 5
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SOURCE American Academy of Dermatology
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