Psoriasis treatment: Cyclosporine

Cyclosporine was first approved to prevent the body from rejecting a transplanted organ. When given to organ-transplant recipients who had psoriasis, patients discovered that the medicine also effectively treated their psoriasis. Since that discovery, the US Food and Drug Administration (FDA) has approved cyclosporine to treat psoriasis in adults who have extensive or disabling psoriasis.

Why do dermatologists prescribe cyclosporine to treat psoriasis?

Cyclosporine works quickly to treat extensive or disabling psoriasis. A dermatologist may prescribe it to help a patient gain control of severe psoriasis and then switch the patient to another psoriasis treatment. 

Cyclosporine can effectively treat:

• Plaque psoriasis

• Severe guttate psoriasis

• Erythrodermic psoriasis

• Generalized pustular psoriasis

• Palmoplantar psoriasis

If nothing else will control the psoriasis, a patient may continue taking cyclosporine for a year or longer.

Avoid grapefruit and alcohol

While taking cyclosporine, you should avoid:

• Grapefruit

• Grapefruit juice

• St. John’s Wort

• Drinking alcohol heavily

Dermatologists also prescribe cyclosporine to treat a child who has severe, disabling psoriasis. When cyclosporine is prescribed to treat a child with psoriasis, the child is carefully monitored. This allows a potential side effect to be found early when discontinuing cyclosporine can stop the side effect.

Safety and effectiveness

Cyclosporine can effectively treat severe and disabling psoriasis, and it works quickly. In clinical trials, 80% to 90% of patients who received cyclosporine for 12 to 16 weeks had rapid improvement. 

The preferred way to take cyclosporine is for short periods, such as for 12 to 16 weeks. This can reduce the risk of serious side effects. 

After stopping cyclosporine, patients typically have a good remission (period without psoriasis) time. In studies, patients have remissions that last about 14 weeks. 

Because this medicine suppresses the immune system, dermatologists carefully consider who can safely take this medicine. Before prescribing cyclosporine, your dermatologist will want to know your medical history, what medicines you take, and whether you have kidney disease in your family.

If cyclosporine is a possibility for treating your psoriasis, you will first have medical tests. 

Should you start taking cyclosporine, you’ll need some tests when you first start taking it. You’ll have your blood pressure checked every other week. You’ll also need blood tests. These tests can tell you dermatologist whether the medication is affecting your kidneys or raising your blood pressure. 

If you take cyclosporine for a while, your dermatologist will continue to check your blood pressure, and you’ll need blood tests. 

How to use

Cyclosporine is a pill that you take daily. You should take it at the same time each day. 

It is important to carefully follow the instructions for taking cyclosporine. Many patients gradually increase how much medicine they take. Others gradually decrease the dose after so many weeks. 

Possible side effects

The most serious possible side effects are possible damage to the kidneys and high blood pressure.

Check with doctor before getting vaccinated

Taking cyclosporine? To be safe, check with your dermatologist before getting a vaccine.

To prevent kidney damage, dermatologists carefully select and monitor patients. Treating for 12 weeks and then stopping the cyclosporine until the psoriasis returns can help reduce the risk of kidney damage. 

If blood pressure climbs to an unhealthy level, options for reversing this include lowering the dose of cyclosporine, treating the high blood pressure, or stopping cyclosporine.

Taking cyclosporine also increases the risk of developing a type of skin cancer known as squamous cell carcinoma. This risk is higher if you’ve had more than 200 PUVA treatments. PUVA is a type of light therapy used to treat psoriasis.

Protect yourself from the sun

Sun protection is essential when taking cyclosporine. You want to:

• Seek shade

• Wear pants, long sleeves, and a wide-brimmed hat

• Protect skin not covered by clothing with sunscreen, which has an SPF of 30 or higher and broad-spectrum protection.

Other possible side effects include unhealthy cholesterol levels, excessive hair growth, a pins-and-needles sensation usually caused by pressure or damage to nerves, pain in the muscles and bones, abdominal pain, nausea, vomiting, and diarrhea.

What to discuss with your dermatologist

You should tell your dermatologist if you:

• Experience any side effect

• Need to get a vaccine (check with your dermatologist before getting one)

• Feel uncertain about how to (or how often to) take cyclosporine

• Think the information that came with the medicine about how to take it differs from what your dermatologist told you

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References
Cordoro KM. “Management of childhood psoriasis.” Adv Dermatol. 2008;24:125-69.

Hugh J, Van Voorhees AS, et al. “From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies.” J Am Acad Dermatol. 2014;70:168-77.

Marks, B. “More than skin deep: Triggers, treatments, and you.” An educational session hosted by the National Psoriasis Foundation. Chicago: Presented June 20, 2015.

Menter A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents.” J Am Acad Dermatol2009;61:451-85.