Guía de salud Zest: Educación y asesoramiento sobre medicamentos

Fluocinonide, Fluocinolone, Hydrocortisone, Desonide, Clobetasol
Halobetasol, Betamethasone

Corticosteroids (TCS)

Topical

• Local burning/stinging: 5-15% (varies by vehicle/potency)
• Skin thinning (atrophy) /telangiectasia: rare with short-term use; risk scales with prolonged use (>4 weeks) on thin-skin areas

Elidel (pimecrolimus) & Protopic (tacrolimus)

Calcineurin Inhibitor (TCI)

Topical

• Application site burning/stinging: ~10% – 25% (very common initially; usually resolves after 3–5 days)
• Upper respiratory infections: ~5% – 10%

Eucrisa (crisaborole) & Zoryve (roflumilast)

PDE4 Inhibitor (PDE-4)

Topical

• Application site burning/pain: ~4% – 15%
• Eucrisa: site pain or allergic reactions <1%
• Zoryve: diarrhea: ~2% – 3%, headache: ~2% – 4%, application site pain/burning: <1%

Opzelura (ruxolitinib), Anzupgo (delgocitinib)

JAK Inhibitor (JAK-I)

Topical

• Common cold: ~3% – 6%
• Application site burning/redness: ~1% – 3%
• Note: Systemic adverse events are exceptionally rare (<1%) when staying within standard tube limits.

Vtama (tapinarof)

AhR Agonist

Topical

• Folliculitis (pimple-like bumps): ~20% (vs. ~1% Placebo)
• Contact dermatitis: ~5% – 7%
• Headache: ~4%

Tazarotene (Tazorac)

Retinoid

Topical

• Local irritation, scaling, redness: ~10% – 30%
• Increased sun sensitivity — daily sunscreen is important
• ⚠ Can cause serious harm to a developing baby. Talk to your provider before starting if you are pregnant, planning to become pregnant, or breastfeeding.

Sorilux (calcipotriene), Vectical (calcitriol)

Topical Vitamin D Analogue

Topical

• Burning, peeling, or skin irritation: ~10% – 15%
• Hypercalcemia (high calcium): <1% (only if applied well over the 100g weekly limit)

Rinvoq (upadacitinib) & Xeljanz (tofacitinib)

JAK Inhibitor (JAK-I)

Oral

• Upper respiratory infections: ~12% – 15%
• Cholesterol elevation: ~5% – 8%
• Diarrhea or headache: ~3% – 5%
• Acne: ~10% – 15%
• Serious infection/shingles (herpes zoster): ~1–3% (roughly 2x vs. placebo)

Sotyktu (deucravacitinib)

TYK2 Inhibitor

Oral

• Upper respiratory infections: ~9%
• Headache: ~4% – 6%
• Acne: ~4% – 6%
• Cold sores (herpes simplex): ~2%
• Elevated CPK (a muscle enzyme): ~2–3%

Otezla (apremilast) or roflumilast

PDE4 Inhibitor (PDE-4)

Oral

• Diarrhea: ~16% – 26% (placebo: ~5% – 8%; usually self-resolving in 1–2 weeks)
• Nausea: ~12% – 22% (placebo: ~4% – 7%)
• Tension headache: ~8% – 13%
• Weight loss of >5% body mass: ~10%

Methotrexate

Systemic Antimetabolite

Oral

• Nausea/GI Distress: ~20% – 30% (significantly reduced with folic acid supplementation)
• Liver enzyme elevations: ~10% – 15% (reversible upon temporary hold)
• Increased infection risk: ~10% – 15%
• Fatigue/brain fog ("MTX Fog"): ~10% – 15%

Cyclosporine

Immunosuppressant

Oral

• Kidney changes/creatinine bump: ~10% – 25%
• High blood pressure: ~10% – 20%
• Tremor or tingling: ~10% – 15%
• Infections: ~15% – 25%
• Headache: ~10% – 15%

Soriatane (acitretin)

Retinoid

Oral

• Severely chapped lips and dry mouth/nose: >75%
• Temporary hair thinning: ~10–25%
• Elevated triglycerides: ~25%
• ⚠ Can cause serious harm to a developing baby. Talk to your provider before starting if you are pregnant, planning to become pregnant, or breastfeeding.

Doxycycline, minocycline

Antibiotic

Oral

• Nausea, stomach upset/esophageal irritation: ~10%
• Increased sun sensitivity: ~5% – 10%
• Dizziness/vertigo: unique to Minocycline (~5%) due to how it affects the inner ear

Dupixent (dupilumab)

IL-4/IL-13 Inhibitor

Injection

• Injection site reactions: ~10%
• Upper respiratory infections: ~10% – 13%
• Severe allergic reactions: ~1% or less; mild skin sensitivity in up to ~2%
• Eye-related side effects (conjunctivitis, dry eyes, keratitis): ~8–15% — more common with Dupixent than other biologics. Let your care team know of any eye issues.

Adbry (tralokinumab) & Ebglyss (lebrikizumab)

IL-13 Inhibitor

Injection

• Injection site reactions: ~7% – 11%
• Conjunctivitis (eye inflammation): ~7% – 10%
• Upper respiratory infections: ~5% – 9%
• Adbry: may also cause allergic reactions

Humira, Enbrel, Remicade, Cimzia, Simponi

TNF-α Inhibitor (TNF-I)

Injection

• Serious infections (TB screening required): ~1–2% (~1.5–2x baseline risk)
• Injection site reactions: ~10–15%
• Upper respiratory infections: ~12–17%
• Headache
• Small increased long-term cancer risk; lymphoma very rare (<0.1%, ~2x baseline rate)
• Remicade (IV infusion): infusion reactions possible

Cosentyx (secukinumab), Taltz (ixekizumab), Bimzelx (bimekizumab)

IL-17 Inhibitor

Injection

• Upper respiratory infections: ~11–15%
• Injection site reactions: ~4–9% (Taltz typically on the higher end for injection pain)
• Headache: ~4–6%
• Oral thrush (candidiasis): ~2–4% (Bimzelx targets IL-17A & F, leading to higher rates of ~10–15%)
• Possible new or worsening inflammatory bowel disease — share any IBD history with your provider: rare (<1%)

Siliq (brodalumab)

IL-17 Inhibitor

Injection

⚠ Boxed warning for suicidal ideation and behavior.

Close mood monitoring is required. Contact your care team or a crisis line immediately if you notice mood changes or thoughts of self-harm. This is very rare (<0.1%) and is tracked through a mandatory safety monitoring program (REMS).

Skyrizi (risankizumab), Tremfya (guselkumab), Ilumya (tildrakizumab)

IL-23 Inhibitor

Injection

• Upper respiratory infections: ~13%
• Headache: ~3.5%
• Injection site reactions: ~1.5%
• Fatigue: ~2.5%

Stelara (ustekinumab)

IL-12/23 Inhibitor

Injection

• Nasopharyngitis / upper respiratory infections: ~8% – 14%
• Injection site reactions: ~1% – 2%
• Headache: ~5%
• Fatigue/dizziness: ~2% – 3%

Spevigo (spesolimab)

IL-36 Inhibitor

Injection

• Urinary tract infections: ~9%
• Upper respiratory infections: ~7%
• Headache: ~5% – 7%
• Infusion reactions / itching: ~2%