Psoriasis is a chronic inflammatory skin disease characterized by the formation of plaques and lesions, particularly on the scalp. The symptoms associated with this condition can significantly impact patients' quality of life. While numerous topical products exist to treat the symptoms, some forms of psoriasis, specifically those affecting the scalp, require more advanced therapeutic approaches . These include the use of medications such as methotrexate and acitretin, which can be administered orally or by injection.
On this page, we will explore when these oral and injectable medications are recommended, their benefits, risks, and patient selection criteria.
Overview of oral and injectable treatments for scalp psoriasis
Scalp psoriasis is a manifestation of psoriasis, a chronic inflammatory skin disease, in which psoriatic plaques form on the scalp. These lesions can cause significant pain, as well as cosmetic concerns that impact patients' quality of life. While many topical products are used to treat psoriasis, some patients require systemic treatments to effectively manage their symptoms.
One of the oral medications frequently prescribed for psoriasis is methotrexate. Historically used to treat several conditions, it works by reducing inflammation and plaque formation . Another option for oral treatment is acitretin, which is specifically beneficial for certain forms of psoriasis.
In addition to oral treatments, some medications can be administered by injection. These injections generally target the immune system, reducing the underlying inflammation that causes psoriasis. The dose and frequency of injections vary depending on the patient and the severity of the disease.
However, the use of oral and injectable medications is not without risks. Patients may experience side effects related to these treatments. These effects, although sometimes mild, require close monitoring by a doctor to ensure the safe and effective use of the medication.
The advantages of oral and injectable treatments compared to topical ones
Topical treatments for scalp psoriasis remain a common first line of defense. However, for some patients with more severe or refractory forms of the disease, oral and injectable medications offer undeniable advantages in comparison.
One of the major advantages of oral and injectable treatments is their ability to treat the disease at a systemic level . Rather than targeting only the external symptoms on the skin, these medications, such as methotrexate or acitretin, act on the immune system to reduce the underlying inflammation responsible for the formation of psoriatic plaques. This can be particularly effective for patients whose condition is not limited to the scalp .
Furthermore, they can offer longer-lasting symptom relief. While topical treatments often require daily application, an oral medication or injection can provide beneficial effects for several days or even weeks, depending on the prescribed dose.
Furthermore, the use of oral or injectable medications can be more convenient for many patients. Rather than managing the regular application of creams or lotions, periodic oral administration or injections can simplify the treatment regimen, thereby improving treatment adherence and quality of life .
Finally, given that psoriasis is a chronic disease that can affect other parts of the body besides the scalp, systemic treatments have the advantage of treating the disease as a whole , thus offering a more holistic approach.
The risks and side effects associated with oral and injectable treatments
While oral and injectable treatments offer a promising systemic approach to psoriasis, particularly when it affects the scalp, they also come with potential side effects. These risks, although sometimes limited, require careful evaluation and monitoring to ensure patient safety.
Methotrexate, for example, is a commonly prescribed medication for psoriasis. However, its use can lead to various side effects such as fatigue, liver problems, and increased susceptibility to infections . Clinical studies also suggest a risk of serious adverse effects associated with alcohol consumption while taking methotrexate.
Acitretin, another oral medication, can also cause side effects, such as dry skin and lips, headaches, and increased sensitivity to sunlight . Furthermore, it is crucial for women of childbearing age to discuss the risks with a doctor, as acitretin can cause serious birth defects.
Regarding injectable treatments, their use can sometimes cause a reaction at the injection site, such as redness, pain, or swelling. Some medications administered by injection can also affect the immune system, thus increasing the risk of infections.
It is essential that each patient be informed of these risks and closely monitor for any unusual symptoms. Dose adjustments or a switch to other forms of treatment may be necessary depending on each patient's response and any side effects experienced.
How can we know if a patient can benefit from oral or injectable treatment?
The decision to opt for oral or injectable treatments for scalp psoriasis should not be taken lightly. Several criteria determine whether a patient is a good candidate for these forms of treatment.
Severity of the disease
Patients with moderate to severe forms of psoriasis, where lesions cover a large portion of the scalp or extend to other areas of the skin, may benefit more from systemic drugs such as methotrexate or acitretin.
Response to previous treatments
Patients who have not obtained sufficient relief with topical treatments or who have experienced adverse effects may be considered for a transition to oral or injectable treatments.
Presence of other associated diseases
Patients with co-occurring conditions , such as psoriatic arthritis, may benefit from the fact that oral or injectable medications treat both the skin disease and joint symptoms.
Drug tolerance
Before starting any treatment, it is crucial to know the patient's medical history, particularly regarding drug allergies or adverse side effects they may have experienced with other medications.
Overall health status
The presence of other chronic diseases, such as liver or kidney disorders , could limit the use of certain medications. Similarly, the risks of infection or other complications must be assessed.
Medical follow-up
The patient's ability to visit the doctor regularly for follow-up is essential, as these treatments require constant monitoring to quickly identify any potential adverse effects.
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