Oral Treatment Options for Psoriasis

Traditional Oral Systemic Agents

The American Academy of Dermatology recommends methotrexate as a first-line treatment for moderate to severe psoriasis, with a typical dose of 15 mg weekly initially, and maximum doses of 25-30 mg weekly 1, 2
Methotrexate acts as a competitive inhibitor of dihydrofolate reductase, decreasing folate cofactors required for nucleic acid synthesis, and is effective for both skin psoriasis and psoriatic arthritis 1, 3
Cyclosporine is recommended at doses of 2.5-5 mg/kg daily, with response typically seen within 3 weeks, and requires baseline serum creatinine and blood pressure measurements with regular monitoring of both 2
Acitretin is an oral retinoid dosed at 25-50 mg daily, particularly effective for pustular psoriasis, and requires baseline CBC, lipids, and liver function tests with regular monitoring 2, 4

Fish oil/omega-3 fatty acids may augment the effects of topical, oral-systemic, and phototherapy for chronic plaque psoriasis, and can be considered as an additional supplement in patients with chronic plaque psoriasis 5, 6
Curcumin, the active chemical in turmeric, modulates T-helper type 22 cell activity, and may benefit patients with psoriasis as adjunctive therapy, though literature is limited 5, 6

For mild disease (less than 3% body surface area), topical therapies are generally sufficient, while for moderate to severe disease (3% or more body surface area), oral systemic agents or biologics are typically needed 1, 2
Patients with psoriatic arthritis may benefit from methotrexate or biologics that target TNF-α 7, 2

Methotrexate requires regular liver function monitoring, cyclosporine requires regular blood pressure and renal function monitoring, and acitretin requires monitoring of lipids and liver function 2