Use of cyclosporine and methotrexate in psoriasis

Psoriasis is an inflammatory skin disorder with a worldwide prevalence of 1~3%.As psoriasis usually exhibits chronic courses, the treatment goal is continual control of disease activity without occurrence of serious side effects.More than 15% of patients with psoriasis represents moderate to severe disease activity, in need of systemic treatment in addition to topical treatment.The systemic treatment using acitretin, cyclosporine, methotrexate, and fumarates still have significant role in the management of psoriasis, although newly-developed targeted drugs including biologics and small-molecules showed remarkable efficacies.When choosing a systemic agent, dermatologists should consider its risk and benefit according to the individual patient's status.Here, we aim to review the action mechanism, indication, efficacy, dosing regimen, pharmacokinetics, drug interaction, contraindication, side effects/toxicities, and considerations of cyclosporine and methotrexate use in the treatment of psoriasis.