My son has psoriasis and is on cyclosporine. How to manage?

Hi,

Welcome to icliniq.com.

I completely understand your concern.

Seeing your son struggle with psoriasis for so many years, especially while being on Cyclosporin for so long, can be very worrying for any parent. The good news is that there are newer and far more effective treatment options now available, and many patients who did not improve with older medicines are responding much better to these advanced therapies.

• Biological therapies are now recommended for moderate to severe psoriasis or when conventional treatments (topicals, Methotrexate, Cyclosporin) are insufficient or cause side effects. Biologics are advanced medicines made from living cells (not chemicals), and they target the exact part of the immune system that causes psoriasis, also called targeted therapies, and that is why they show better results in managing the disease.

• Cyclosporin or Methotrexate suppresses the whole immune system.

• Biologics are much more precise; they block one specific pathway, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-17, or IL-23. It comes in injectables mainly and is readily available, like Adalimumab, Etanercept, Infliximab, and Secukinumab.

• For people who refuse or cannot tolerate injections, there is another oral drug, Apremilast.

• Biologics are generally safe and effective, but certain precautions and maintenance steps are important.

  • Before starting treatment, we perform tests for tuberculosis, hepatitis B and C, and basic blood tests to ensure it is safe. If there is any active infection, biologic therapy is delayed until the infection clears.

  • Among the available options, the choice of biological therapy is based on the severity of the disease, comorbid history, age, budget, and involvement of joints.

• Apart from biological therapy, you can also go for phototherapy, as it is another effective option that can be combined or used alone; it helps clear lesions without causing systemic side effects and requires less systemic medication.

• While older systemic therapies such as Cyclosporin, Methotrexate, Retinoids, or broad immunosuppressants are still listed among treatments for psoriasis in many cases, they are no longer the first choice, especially for long-term management, due to side effects.

I hope my answer is clear to you, and if you need any details at any time, I am here and at your service.

Thank you.