Management of Psoriasis with Systemic Non-Biological Therapies

Patient Guideline Summary

Publication Date: March 1, 2020



This patient summary means to discuss key recommendations from the American Academy of Dermatology (AAD) for the care for the management of psoriasis with systemic nonbiologic therapies. It is limited to adults 18 years of age and older and should not be used as a reference for children.



  • Psoriasis Vulgaris is a chronic inflammatory skin disease.
  • It typically presents with well-defined pink plaques with a silvery scale.
  • It commonly involves the scalp, elbows, knees, and presacral region, but it can affect any area of skin.
  • Psoriasis is an immune-mediated condition.
  • Although helpful in most psoriasis treatment regimens, topical therapies are frequently inadequate to get and maintain skin clearance.
  • This patient summary focuses on the use of oral-systemic, nonbiologic medication in the treatment of psoriasis.



Important Note:
For each of the drugs listed below, there are conditions and chronic diseases that forbid their use or advise caution if used. It is important to check them with your doctor. Pregnancy, nursing, liver diseases, blood diseases, allergic reactions, diabetes, immunodeficiency, cancers, decreased kidney function are examples of these conditions.

Common treatments:
  • Methotrexate
  • Apremilast
  • Cyclosporine
  • Acitretin
  • Tofacitinib
  • Fumaric acid ester

Other treatments:
  • Hydroxyurea
  • Mycophenolate mofetil
  • Azathioprine
  • Leflunomide
  • Tacrolimus
  • Thioguanine
Note: these treatments are rarely used


  • AAD: American Academy Of Dermatology

Source Citation

Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Prater EF, Rahimi RS, Rupani RN, Siegel M, Stoff B, Strober BE, Tapper EB, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020 Jun;82(6):1445-1486. doi: 10.1016/j.jaad.2020.02.044. Epub 2020 Feb 28. PMID: 32119894.


The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.