Oral systemic agents are also used for moderate to severe psoriasis. Methotrexate taken on a weekly basis has been used for years. Oral cyclosporine has been used with great success for erythrodermic and pustular psoriasis. Its use is limited to 6 to 12 months because of nephrotoxicity. Many biological agents have become available over the last decade. These medications are given by subcutaneous, intramuscular, or intravenous injection. They include etanercept, alefacept, adalimumab, infliximab, and ustekinumab. All of these agents have had excellent response rates. They are all considered to be immunosuppressive, and patients taking these medications need close clinical follow-up, because they are at increased risk for infections and possibly for systemic cancers, such as lymphoma, after years of use.
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