Oral contraceptives, also known as "birth control pills" or "the pill," are taken to prevent pregnancy. When taken correctly to prevent pregnancy, oral contraceptives have a failure rate of approximately 1% per year (1 pregnancy per 100 women per year of use) when used without missing any pills. The typical failure rate is approximately 5% per year (5 pregnancies per 100 women per year of use) when women who miss pills are included. For most women oral contraceptives are also free of serious or unpleasant side effects. However, forgetting to take pills considerably increases the chances of pregnancy.
Topical medications effective for psoriasis available by prescription include those that contain topical steroids of various potencies. Typical steroid medications are halcinonide ( Halog , Halog-E ), flurandrenolide ( Cordran , Cordran SP , Cordran Tape ), betamethasone ( Luxiq ), desonide ( Desonate ), alclometasone ( Aclovate ), mometasone ( Elocon ), fluocinonide ( Vanos ), and triamcinolone acetonide ( Kenalog ). Tar-containing topicals and vitamin D -like molecules (calcipotriol [ Taclonex ]/calcipotriene [ Dovonex ]) also can be helpful. Ultraviolet light administered under controlled conditions in a physician's office in various wavelengths (narrow-band UVB) with or without supplemental medication (8-methoxypsoralen) ( PUVA treatment) is a very effective therapy. Systemic therapies include a vitamin A -like drug, acitretin ( Soriatane ), short-term cyclosporine ( Gengraf , Neoral , Sandimmune ) therapy for severe flares, and methotrexate ( Rheumatrex Dose Pack , Trexall ). A new oral drug, apremilast (Otezla), has recently become available that seems to work best for mild to moderate psoriasis. New and expensive targeted drugs called biologics, which include etanercept ( Enbrel ), adalimumab ( Humira ), infliximab ( Remicade ), ustekinumab ( Stelara ), secukinumab (Cosentyx), and ixekizumab (Taltz), are now available. These newer products are produced by new technologies requiring their synthesis by living cells. They are proteins and all currently must be given by injection at various intervals into the subcutaneous tissue by the patient or by intravenous infusion in a medical facility. They are unique in that they have precise targets in the in the inflammatory pathway that they block. Since the biologics are very, very specific in their mode of action, they claim to offer increased safety and improved efficacy over older less specific immunosuppressive drugs.
In spite of warnings against the use of bioidentical hormones, there has been continued growth of the industry. In a survey of compounding and community pharmacies in the United States, it was estimated that prescription rates for custom-compounded bioidentical hormones now approach those of US Food and Drug Administration (FDA)-approved MHT prescriptions [ 45 ]. Similar results were reported in a second study [ 51 ]. This highlights the importance of physician and patient education about the differences between approved products and less-regulated hormone formulations.