One Medicine For Another to Beat Dry Skin

Psoriasis systemic treatments less likely to be needed if SSRIs are taken beforehand

/ Author:  / Reviewed by: Dominique Brooks, M.D

(RxWiki News) Some treatments for psoriasis can affect the whole body beyond the red, dry and irritated skin. These systemic treatments might cause some concern, but patients have other options and may not have to use them.

Psoriasis patients who took certain medicines typically used for depression were half as likely to need a systemic psoriasis treatment that affects the whole body later on, new research shows.

Selective serotonin reuptake inhibitors (SSRIs) affect chemical signals in the brain by blocking serotonin from being reabsorbed by the brain.

SSRIs, which are typically prescribed to treat depression, could be used as a first-line treatment for psoriasis, according to the researchers.

"Ask your dermatologist about all the psoriasis treatment options."

The aim of the study, led by Kristofer Thorslund, PhD, from the Dermatology and Venereology Unit at the Karolinska Instituet in Sweden, was to see if SSRIs (Celexa, Lexapro, Prozac, Zoloft) could affect psoriasis severity.

The study looked at more than 2,500 patients with plaque psoriasis who were identified in the National Patient Register in Sweden.

At the start of the study, 89 percent of the patients had mild psoriasis. The patients were 55 years old on average and almost two-thirds were women.

Half the patients had prescriptions for SSRIs that were dispensed twice within a six-month period between July 2006 and April 2008.

The researchers compared changes in psoriasis severity between the two groups by noting which patients changed psoriasis treatments within six months after starting the SSRIs.

The researchers specifically tracked the number of patients who went from a non-systematic psoriasis treatment, which targets a specific part of the body, to a systemic treatment that affects the whole body.

The chance of switching from a non-systematic to systemic psoriasis treatment was cut by 56 percent among patients who were took an SSRI compared to patients who did not, the researchers found.

Among patients who had mild psoriasis and used an SSRI, only 29 patients switched from non-systematic to systemic treatments, compared to 42 patients who did not use an antidepressant.

On the other hand, patients with severe psoriasis who had used an SSRI were about 20 percent more likely to change medicine types.

In total, 42 patients with severe psoriasis switched treatment types after using an SSRI compared to 37 patients who did not use the SSRI.

"Use of SSRIs in psoriasis is associated with a decreased need for systemic psoriasis treatment," the researchers wrote in their report. "To our knowledge, this ļ¬nding has not been previously reported."

The authors also said that future studies should investigate how SSRIs could potentially be used as an easily accessible treatment option for the skin condition.

Glenn Kolansky, MD, a board-certified dermatologist and dailyRx Contributing Expert who is not affiliated with the study, said that further research involving larger populations would be advised to see if there is valid clinical reason to prescribe the SSRI medications.

"Stress is known to increase the severity of psoriasis, however, we do not know the threshold to switch to systemic medications," Dr. Kolansky said. "These medications are antidepressants and are not without their own side effect profile."

The authors noted several limitations with their study, including that psoriasis severity might have been misclassified. The researchers said that the likelihood of that possibility was similar for both groups of patients.

Another limitation is that dermatologists might have delayed changing psoriasis treatments though the severity of the psoriasis may have changed first.

Patients who stopped treatment after one to two months due to side effects were not included in the study. Further, the researchers did not track any elated illnesses and other medications taken at the same time.

The study, funded by the Swedish Psoriasis Association, was published online June 1 in the Journal of Internal Medicine. The authors declared no conflicts of interest.

Reviewed by: 
Review Date: 
June 4, 2013
Last Updated:
August 7, 2013