Methotrexate was discovered to be effective in clearing psoriasis during the 1950s and was eventually approved for this use in the 1970s. In psoriasis, methotrexate works by preventing the excessive division and multiplication of the skin cells that cause skin scaling and raised plaques. It is used only when the condition is severe and unresponsive to conventional treatments as it has many potential side effects. It is also used in treating psoriatic arthritis, so can benefit both conditions at the same time. In men and women considering starting a family, there is a three-month washout period to become drug-free. Methotrexate is also no considered suitable during pregnancy.
Ciclosporin is another immunosuppressant, originally used to prevent transplant patients from rejecting their new organs. Doctors noticed that transplant patients who had a previous history of psoriasis tended to have fewer plaques post transplant and so further research was carried out specifically in psoriasis patients. This revealed ciclosporin to be a quick acting agent. It is usually taken as a short course, but can be taken continuously for up to one year.
Ciclosporin is highly effective in severe psoriasis resistant to other treatments (refractory). How exactly it works is not fully understood, but it may inhibit epidermal hyperproliferation (high rate of cell division) by suppressing T lymphocyte (white blood cells) activity in the lower (dermis) and upper (epidermis) layers of psoriatic skin.
Immunosuppressant treatments require regular monitoring, which may include blood tests, blood pressure monitoring and other regular check-ups.
Women of child-bearing age should avoid becoming pregnant while taking ciclosporin. Discuss with your doctor which types of contraception are suitable for you and your partner.