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. |