Starting a new medication can bring up a lot of questions. What will it feel like? What should I watch out for? Is what I'm experiencing normal? These are all valid things to wonder about — and you deserve clear, honest answers.
Please note: this guide covers common side effects for each medication — it's not a complete list of everything that's possible. Think of it as a reference you can come back to whenever you need it. And remember: your Zest care team is always here to walk you through anything.
Topical Medications
Topicals are applied directly to the skin and are often the first step in a treatment plan.
Fluocinonide, Fluocinolone, Hydrocortisone, Desonide, Clobetasol
Halobetasol, Betamethasone
- 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)
- Application site burning/stinging: ~10% – 25% (very common initially; usually resolves after 3–5 days)
- Upper respiratory infections: ~5% – 10%
Eucrisa (crisaborole) & Zoryve (roflumilast)
- 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)
- Common cold: ~3% – 6%
- Application site burning/redness: ~1% – 3%
- Note: Systemic adverse events are exceptionally rare (<1%) when staying within standard tube limits.
- Folliculitis (pimple-like bumps): ~20% (vs. ~1% Placebo)
- Contact dermatitis: ~5% – 7%
- Headache: ~4%
- 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
- Burning, peeling, or skin irritation: ~10% – 15%
- Hypercalcemia (high calcium): <1% (only if applied well over the 100g weekly limit)
Oral Medications
Oral medications work throughout the body to manage inflammation or your immune response. Your provider will walk you through what to expect before you start.
Rinvoq (upadacitinib) & Xeljanz (tofacitinib)
- 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)
- 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
- 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%
- 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%
- Kidney changes/creatinine bump: ~10% – 25%
- High blood pressure: ~10% – 20%
- Tremor or tingling: ~10% – 15%
- Infections: ~15% – 25%
- Headache: ~10% – 15%
- 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.
- 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
Biologics
Biologics are injectable or infused medications that target very specific parts of the immune system. They're typically used for moderate to severe skin conditions when other treatments haven't provided enough relief.
Shared consideration: Because biologics target specific parts of the immune system, an increased risk of infections is a shared consideration across this entire class. Your provider will screen you before starting and monitor you throughout your treatment.
- 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)
- 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
- 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)
- 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%)
⚠ 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)
- Upper respiratory infections: ~13%
- Headache: ~3.5%
- Injection site reactions: ~1.5%
- Fatigue: ~2.5%
- Nasopharyngitis / upper respiratory infections: ~8% – 14%
- Injection site reactions: ~1% – 2%
- Headache: ~5%
- Fatigue/dizziness: ~2% – 3%
- Urinary tract infections: ~9%
- Upper respiratory infections: ~7%
- Headache: ~5% – 7%
- Infusion reactions / itching: ~2%
Phototherapy (Light Therapy)
Narrowband UVB (NB-UVB)- Phototherapy uses controlled doses of ultraviolet light to slow overactive skin cell growth and reduce inflammation. Your provider will calibrate your dose and adjust it as your skin responds.
Common side effects can include:
- Redness, similar to a mild sunburn — especially in the first few sessions
- Burns, blistering, or scabbing if the dose is too high
- Pigment changes — skin may temporarily appear lighter or darker in treated areas
- Pain or discomfort during or after sessions
- A small increased risk of skin cancers with long-term use — your provider will monitor your skin regularly
When to Contact Your Zest Care Team
Side effects can feel unsettling, especially when you're just getting started. Here's a simple way to think about it:
- Mild, temporary side effects are common and often improve as your body adjusts
- Persistent or worsening symptoms are worth a message — even if you're not sure it's related to your medication
- Anything sudden, severe, or that worries you deserves prompt attention
You know your body. Trust that. Your Zest care team is available 24/7 — you never have to sit with uncertainty alone.
Have questions about a medication you’ve been prescribed, or not sure whether what you’re feeling is normal? Reach out through your Zest portal — your care team is here.
