TY - JOUR T1 - Systemic agents for psoriasis and their relevance to primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 96 LP - 97 DO - 10.3399/bjgp19X701225 VL - 69 IS - 679 AU - Simon Tso AU - William Hunt AU - Helen Frow AU - Andrew Ilchyshyn Y1 - 2019/02/01 UR - http://bjgp.org/content/69/679/96.abstract N2 - Psoriasis is a common chronic autoimmune inflammatory disease. There is an increasing range of systemic agents prescribed by specialists in the management of psoriasis. Thus, it is important for clinicians to become familiar with these medicines. This article aims to answer questions commonly asked about these medicines in relation to their side effects and their impact on vaccinations, preconception planning, breastfeeding, infection management, and major elective surgery.Box 1 provides a selected example of important side effects of systemic agents used in psoriasis. The list of side effects is not exhaustive and it is based on the authors’ perceived importance even though they may be rare.Box 1. Important side effects and preconception advice for systemic agents used in psoriasisDrugSide effects not to be missedTime needed by patients to be off treatment before conceptionAcitretina,bHyperlipidaemia, hair loss, deranged liver enzymes, calcinosis in tendons3 years for femalesCiclosporinInfections,a hypertension, renal impairment, cancer risksbCan be used during pregnancy if potential benefit outweighs the risksMethotrexateInfections,a agranulocytosis, liver and lung fibrosis, cancer risksbAt least 3 months for males and femalesDimethyl fumarateFlushing, liver and renal impairment, diarrhoea, progressive multifocal leukoencephalopathyNo dataApremilastDiarrhoea, depression, weight lossNo dataBiologics and biosimilarsInfections,a cancer risks,b demyelinating disorders (anti-TNF-α)Variable — up to 6 months for females↵a Cancer risks of systemic agents are discussed by Geller and colleagues1 and their skin cancer risks could be ranked as follows: ciclosporin > methotrexate … ER -