Table of ContentsView AllTable of ContentsMethotrexateBiologic DrugsCorticosteroidsHow to Self-InjectFAQs
Table of ContentsView All
View All
Table of Contents
Methotrexate
Biologic Drugs
Corticosteroids
How to Self-Inject
FAQs
Psoriasis injections are commonly used in people with moderate to severepsoriasiswho do not respond to topical or oral treatments.Methotrexate, an immune suppressant drug, andbiologic drugssuch as Enbrel (etanercept), Humira (adalimumab), and Stelara (ustekinumab) are examples of injectable psoriasis medications.
In addition to these, injectedcorticosteroids(steroids) may be used on occasion to bring a psoriasis flare-up under control.
Each of these injectable drugs works differently but ultimately dampens the overactive immune response that triggerspsoriasisandpsoriatic arthritissymptoms.
Kanok Sulaiman / Getty Images
How Psoriasis Is Treated
Injectable Methotrexate for Psoriasis
Methotrexateis a drug used to treat certain cancers and autoimmune diseases likerheumatoid arthritisand psoriasis. It is both animmunosuppressant(meaning that it suppresses the immune system) and an antiproliferative agent (meaning it slows the growth of cells).
These actions are useful for autoimmune diseases, as these involve the body’s own immune system attacking normal cells, causinginflammation. With psoriasis, the inflammation causes skin cells to proliferate and accumulate faster than they can be shed, leading to itchy, scaly patches calledplaques.
Because methotrexate hampers the underlying cause of autoimmune diseases, it is classified as adisease-modifying antirheumatic drug (DMARD).
Recommended Dosages
Methotrexate may be given at a single consistent dose. But, due to the risk ofanemiaand otherside effects, some healthcare providers prefer to start at a lowerloading doseto get your body accustomed to the drug before increasing the optimaltherapeutic dose.
The dosage of the drug is described in milligrams (mg).
A methotrexate dose can be adjusted up or down as needed to clear skin plaques with minimal side effects. It takes about a month before you will see and feel the effects of treatment.
Administration
Subcutaneous methotrexate can be useful for people who experience severe gastrointestinal symptoms from oral methotrexate, such as nausea and vomiting or stomach ulcers.
Another benefit of subcutaneous injections is that you can give yourself shots at home; intravenous (IV) infusions need to be administered in a medical setting.
Even so, people who are unwilling or unable to give themselves shots may be better suited for intravenous methotrexate infusions.
Injectable Biologic Drugs for Psoriasis
Biologics are medicines derived from human or animal proteins, rather than those created in the lab. These drugs suppress facets of the immune response, rather than the immune system as a whole.
Although biologic drugs do causeside effects, they tend to be less severe than those of other options—which is why some experts are calling for them to be used earlier on in treatment.
Biologics are traditionally used for prescribed to people with moderate to severeplaque psoriasisor psoriatic arthritis who have not responded to other treatments or who have experienced intolerable side effects from them.
These drugs can be used on their own or in combination with methotrexate or other drugs commonly used to treat autoimmune diseases.
Among the biologics most commonly used to treat psoriasis or psoriatic arthritis are:
Depending on the drug used, you may need an injection every one to 12 weeks. If there is no improvement in your symptoms after 12 to 16 weeks, the treatment is generally stopped.
How Effective Are Biologic Drugs?
Each biologic has different preparation and dosing instructions. Yourrheumatologistwill walk you through what to do, but you should also read the package instructions to avoid errors.
To prevent scarring, change the location of the subcutaneous injection site with every shot.
Biologic vs. Biosimilar Drugs
Injectable Corticosteroids
Corticosteroids(steroids) are less commonly used to treat psoriasis as their prolonged use can lead to serious side effects likeglaucomaandosteoporosis.
Even so, injected steroids have their place in the treatment of severe psoriasis flare-ups when topical and oral medications fail to provide relief.
The main benefits of steroid injections are that they are fast-acting and the skin clearance can sometimes last for weeks or months.Even so, they are not considered the ideal choice for the ongoing treatment of psoriasis and are generally intended for short-term use.
The steroids most commonly used for the treatment of psoriasis and psoriatic arthritis include:
As a general rule, the lowest possible dose is given to resolve the symptoms.
If used for a longer period of time, the steroid dose will need to betapered downgradually to avoidwithdrawaland a rebound of psoriasis symptoms.
For severe psoriatic arthritis flare-ups, anintra-articular injection(into a joint space) may be given to reduce joint inflammation.
How to Give Yourself a Psoriasis Injection
Methotrexate and some biologic agents are available as a single-use, prefilled syringe or a pen-like, disposable auto-injector.
The injection procedure is essentially the same for each. The only difference is that a syringe has a plunger that you depress after the needle is inserted. With an auto-injector, the unit is placed against the skin and the needle automatically lowers after you press a button.
Injectable psoriasis drugs need to be kept at temperatures between 36 and 46 degrees F.Leave your medication in the refrigerator until you are ready to use it, then follow these steps.
To self-inject yourself with a prefilled syringe:
To inject yourself with a disposable auto-injector:
Frequently Asked QuestionsYes, corticosteroid shots are often used to treat psoriasis when topical steroid treatments aren’t enough. Your healthcare provider will carefully inject a corticosteroid directly under the skin of your rash.Not typically. Corticosteroids can help to stop the itching and clear up psoriasis plaques. The effects of corticosteroids last anywhere from a few weeks to a few months. Once the shot wears off, however, the rash may return.Side effects of psoriasis injections range from mild skin irritation at the injection site to more severe systemic reactions. Some people experience flu-like symptoms for a few days after a shot. Fatigue is a common side effect of biologics that may last throughout the treatment.
Frequently Asked Questions
Yes, corticosteroid shots are often used to treat psoriasis when topical steroid treatments aren’t enough. Your healthcare provider will carefully inject a corticosteroid directly under the skin of your rash.
Not typically. Corticosteroids can help to stop the itching and clear up psoriasis plaques. The effects of corticosteroids last anywhere from a few weeks to a few months. Once the shot wears off, however, the rash may return.
Side effects of psoriasis injections range from mild skin irritation at the injection site to more severe systemic reactions. Some people experience flu-like symptoms for a few days after a shot. Fatigue is a common side effect of biologics that may last throughout the treatment.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bedoui Y, Guillot X, Selambarom J, et al.Methotrexate an old drug with new tricks.Int J Mol Sci.2019 Oct;20(20):5023. doi:10.3390/ijms20205023Menter A, Gelfand JM, Connor C, et al.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):1445-86. doi:10.1016/j.jaad.2020.02.044Dermatology News.Biologic guidelines for psoriasis let providers choose.Brownstone ND, Hong Ju, Mosca M, et al.Biologic treatments of psoriasis: an update for the clinician.Biologics.2021;15:39–51. doi:10.2147/BTT.S252578American Academy of Dermatology Association.Psoriasis treatment: biologics.Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci.2020 Mar;21(5):1690. doi:10.3390/ijms21051690Gregoire ARF, DeRuyter BK, Stratman EJ.Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis.JAMA Dermatol.2021 Feb;157(2):1–4. doi:10.1001/jamadermatol.2020.4219Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30Liu JT, Yeh HM, Liu SY, Chen KT.Psoriatic arthritis: epidemiology, diagnosis, and treatment.World J Orthop.2014 Sep 18;5(4):537–43. doi:10.5312/wjo.v5.i4.537
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bedoui Y, Guillot X, Selambarom J, et al.Methotrexate an old drug with new tricks.Int J Mol Sci.2019 Oct;20(20):5023. doi:10.3390/ijms20205023Menter A, Gelfand JM, Connor C, et al.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):1445-86. doi:10.1016/j.jaad.2020.02.044Dermatology News.Biologic guidelines for psoriasis let providers choose.Brownstone ND, Hong Ju, Mosca M, et al.Biologic treatments of psoriasis: an update for the clinician.Biologics.2021;15:39–51. doi:10.2147/BTT.S252578American Academy of Dermatology Association.Psoriasis treatment: biologics.Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci.2020 Mar;21(5):1690. doi:10.3390/ijms21051690Gregoire ARF, DeRuyter BK, Stratman EJ.Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis.JAMA Dermatol.2021 Feb;157(2):1–4. doi:10.1001/jamadermatol.2020.4219Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30Liu JT, Yeh HM, Liu SY, Chen KT.Psoriatic arthritis: epidemiology, diagnosis, and treatment.World J Orthop.2014 Sep 18;5(4):537–43. doi:10.5312/wjo.v5.i4.537
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bedoui Y, Guillot X, Selambarom J, et al.Methotrexate an old drug with new tricks.Int J Mol Sci.2019 Oct;20(20):5023. doi:10.3390/ijms20205023Menter A, Gelfand JM, Connor C, et al.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):1445-86. doi:10.1016/j.jaad.2020.02.044Dermatology News.Biologic guidelines for psoriasis let providers choose.Brownstone ND, Hong Ju, Mosca M, et al.Biologic treatments of psoriasis: an update for the clinician.Biologics.2021;15:39–51. doi:10.2147/BTT.S252578American Academy of Dermatology Association.Psoriasis treatment: biologics.Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci.2020 Mar;21(5):1690. doi:10.3390/ijms21051690Gregoire ARF, DeRuyter BK, Stratman EJ.Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis.JAMA Dermatol.2021 Feb;157(2):1–4. doi:10.1001/jamadermatol.2020.4219Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30Liu JT, Yeh HM, Liu SY, Chen KT.Psoriatic arthritis: epidemiology, diagnosis, and treatment.World J Orthop.2014 Sep 18;5(4):537–43. doi:10.5312/wjo.v5.i4.537
Bedoui Y, Guillot X, Selambarom J, et al.Methotrexate an old drug with new tricks.Int J Mol Sci.2019 Oct;20(20):5023. doi:10.3390/ijms20205023
Menter A, Gelfand JM, Connor C, et al.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):1445-86. doi:10.1016/j.jaad.2020.02.044
Dermatology News.Biologic guidelines for psoriasis let providers choose.
Brownstone ND, Hong Ju, Mosca M, et al.Biologic treatments of psoriasis: an update for the clinician.Biologics.2021;15:39–51. doi:10.2147/BTT.S252578
American Academy of Dermatology Association.Psoriasis treatment: biologics.
Kamata M, Tada Y.Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review.Int J Mol Sci.2020 Mar;21(5):1690. doi:10.3390/ijms21051690
Gregoire ARF, DeRuyter BK, Stratman EJ.Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis.JAMA Dermatol.2021 Feb;157(2):1–4. doi:10.1001/jamadermatol.2020.4219
Liu D, Ahmet A, Ward L, et al.A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.Allergy Asthma Clin Immunol. 2013;9(1):30. doi:10.1186/1710-1492-9-30
Liu JT, Yeh HM, Liu SY, Chen KT.Psoriatic arthritis: epidemiology, diagnosis, and treatment.World J Orthop.2014 Sep 18;5(4):537–43. doi:10.5312/wjo.v5.i4.537
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