Non-biologic Systemic Immunosuppressants/Non-Immunosuppressants

• Acitretin has unique utility as it is safe and efficacious for elderly patients, enhances phototherapy, is not an immunosuppressant and is likely anticancer

• Cyclosporin at maximum dermatologic dose of 5 mg/kg per day will clear up almost any psoriasis in 3 months or less. Do not let serum creatinine increase by more than 30% of the baseline. After using daily (uninterrupted) for 2 years the patient must take a break.

• Deucravacitinib, an effective oral therapy, is a TYK-2 inhibitor. It can be used first line with no drug-drug interaction, no dosage adjustment for any degree of renal impairment, with no black box warning.