Systemic therapy

Mode of action

Dosing regime

Therapy specific absolute contraindications

Special considerations

Acitretin

Synthetic aromatic analogue of retinoic acid.

Mechanism not fully understood, modulates epidermal differentiation and proliferation, also has anti-inflammatory and immunomodulatory effect. No immunosuppressive effect.

daily

Severe renal or hepatic impairment

pregnancy, breastfeeding, alcoholism,

blood donation, severe hyperlipaemia, comedication with MTX, tetracyclines, vitamin A containing products, retinoids

Teratogenic-avoidance during pregnancy is mandatory.

Effective contraceptive measures up to three years after discontinuation of therapy

Apremilast

Inhibitor of phosphodiesterase 4 (PDE4); elevates intracellular cAMP levels, which in turn down-regulates the inflammatory response by modulating the expression of TNF-α, IL-23, IL-17 and other inflammatory cytokines

daily

Pregnancy

Dose reduction is needed in patients with severe renal impairment. Special caution in patients with unexplained and clinically significant weight loss

Cyclosporin

Immunosuppressive agent, calcineurin inhibitors

daily

Renal impairment, insufficiently controlled arterial hypertension, severe infectious disease, history of malignancy, current malignancy, simultaneous PUVA therapy, combination with products containing Hypericum perforatum (St. john’s worth), combination with medicines that are substrate for P-glycoprotein or OATP transporter

Potential for multiple drug interactions. Usually for short periods only.