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Systemic Treatments

Select Treatments:
  • What is it and how does it work?
  • Who is this for?
  • Who is this not for?
  • How well does it work?
  • What are the possible side effects?
  • Will it inconvenience me?
  • How much does it cost?

Systemic Treatments

What is it and how does it work?

ExampleGenericPills
e.g. Generic pills


ExampleGenericLiquid
e.g. Liquid solutions

Acitretin (E.g. Soriatane, Neotigason)

Acitretin is swallowed as a pill. It may regulate shedding and growth of skin cells.

Apremilast (E.g. Otezla)

Apremilast is swallowed as a pill. It helps reduce  inflammation and skin thickening.

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)

Cyclosporine is swallowed as a pill or liquid. It reduces inflammation of psoriasis.

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)

Methotrexate is a pill or injection. It slows skin cell growth and reduces inflammation.

Who is this for?

Acitretin (Brand: Soriatane, Neotigason)

Moderate to severe psoriasis.

Apremilast (E.g. Otezla)

Moderate to severe psoriasis.

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)

Moderate to severe psoriasis. Or, if at least one other systemic treatment has not worked.

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)

Moderate to severe psoriasis. Or, if at least one other form of treatment has not worked.

Who is this not for?

Acitretin (E.g. Soriatane, Neotigason)

You may not be able to take acitretin if you have:

  • liver or kidney disease
  • high triglycerides
  • a sensitivity or allergy to retinoids.

Talk to your doctor to find out if this treatment is right for you.

Apremilast (E.g. Otezla)

This drug should not be taken if you:

  • have a history of depression
  • are currently on medication for seizures, HIV/AIDS, or tuberculosis
  • have an allergy or sensitivity to apremilast

Talk to your doctor to find out if this treatment is right for you.

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)

You may not be able to take this drug if you:

  • have certain health problems
  • are taking certain medications
  • are receiving phototherapy
  • have sensitivity to cyclosporine

Talk to your doctor to find out if this treatment is right for you.

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)

This drug should not be taken if you have:

  • severe infection
  • liver disease
  • kidney failure
  • alcoholism
  • blood cell disorders
  • allergy or sensitivity to methotrexate

Talk to your doctor to find out if this treatment is right for you.

How well does it work?

Acitretin (E.g. Soriatane, Neotigason)










69 out of 100 people saw expect excellent improvement because of the drug. Some people saw improvement as early as 5 weeks.

(2/3 stars evidence)

Apremilast (E.g. Otezla)










Between 11 and 41 out of 100 people saw excellent improvement after 16 weeks because of the treatment, depending on the dosage.

(3/3 stars evidence)

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)










Between 28 and 97 out of 100 people saw excellent improvement because of the treatment, depending on the dosage. Some saw improvement as early as 1 week.

(2/3 stars evidence)

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)










41 out of 100 people saw excellent improvement after 16 weeks because of the treatment.

(2/3 stars evidence)

What are the possible side effects?

Acitretin (E.g. Soriatane, Neotigason)

Serious: Some people have reported serious side effects while taking this drug. These include liver damage, pressure in the brain, and impaired night vision. There is not enough evidence to show the exact chances of having these side effects.

Other: Dry skin, dry lips and eyes, possible hair loss, sore joints, and increased blood fat levels.

Pregnancy: Category X. This drug is not safe while pregnancy or breastfeeding. If you are pregnant or planning to get pregnant, let your doctor know.

Apremilast (E.g. Otezla)

Serious:










4 out of 100 people reported severe abdominal pain.

Other: Nausea, diarrhea, headache, and common cold.

Pregnancy: Category C. We do not yet know if there is a risk of taking this drug during pregnancy. If you are pregnant or planning to get pregnant, let your doctor know.

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)

Serious: Possible risk of serious side effects. This includes, kidney damage, blood disorders, heart disease, inflammation of the pancreas, and nerve disorders. There is not enough evidence to show the exact chances of having these side effects.

Other: Gum growth, excess hair growth, and blood disorders.

Pregnancy: Category C. We do not yet know if there is a risk of taking this drug during pregnancy. It should not be taken while breastfeeding. If you are pregnant or planning to get pregnant, be sure to tell your doctor.

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)

Serious: Possible risk of serious side effects, including skin cancer, viral infections, eye damage, and bone marrow malfunction. There is not enough evidence to show the exact chances of having these side effects.

Other: Nausea, hair loss, ulcers, liver or bone problems, discomfort.

Pregnancy: Category X. This drug is not safe while pregnancy or breastfeeding. If you or your partner is pregnant or planning to get pregnant, let your doctor know. This drug also affects sperm. Men should wear condoms during treatment and 90 days after treatment ends.

Will it inconvenience me?

Acitretin (E.g. Soriatane, Neotigason)

This treatment involves taking pills every day. May cause dryness and make wearing contact lenses difficult.

Apremilast (E.g. Otezla)

This treatment involves taking a pill twice a day.

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)

This treatment involves taking pills daily.

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)

This treatment involves injections or taking pills weekly. After practice at a clinic, you can give yourself injections at home.

How much does it cost?

Acitretin (Brand: Soriatane, Neotigason)

Prices vary but may range from $2,900 - $11,300 USD/year.

Apremilast (E.g. Otezla)

Prices vary but may range from $31,600 - $33,700 USD/year.

Cyclosporine (E.g. Apo-Cyclosporine, Sandimmune, Cicloral, Gengraf, Deximune)

Prices vary but may range from $1,100 - $4,200 USD/year.

Methotrexate (E.g. Apo-Methotrexate, Otrexup, Trexall, Rheumatrex, Rasuvo)

Prices vary but may range from $200 - $700 USD/year.

Prices as of 2016 and may vary by region.

Click here for information about accessing and paying for treatment in Canada