The antipsoriatic effect of MTX during the remission-induction phase of treatment is influenced by folate status and may be significantly less if combined treatment with FA is used, irrespective of pre-treatment folate levels. The individual tailoring of MTX dosing needs further attention because the mean percent PASI improvement from baseline was 83% and the inter-patient variability in response was low after 16 weeks of monotherapy with MTX.

The patch test results of 12 058 patients (4416 male and 7642 female) referred to 9 clinics in the Czech Republic between January 1997 and December 2001 were evaluated. Patients were tested with the same series of allergens by using the standardized patch testing method. The current standard tool for diagnosing allergic contact dermatitis (ACD) in the Czech Republic is the Trolab test panel (Hermal, Reinbeck, Germany) which consists of 23 allergens. Only a few data exists on ACD in the Czech Republic. All patients were tested with the 23 allergen European standard series. Of these patients, 7661 (63.5%) had 1 or more positive reactions. On average, there were 2.8 positive reactions per patient. ACD, according to clinical relevance, was diagnosed in 5339 (69.7%) of these patients. The most frequent allergens were metals (22.9%), especially nickel sulfate (13.8%), and followed by Myroxylon pereirae resin (balsam of Peru) (7.3%), fragrance mix (5.8%), formaldehyde (4.2%) and lanolin alcohol (3.0%). Our results were compared with results from other countries. We conclude that the European standard series is suitable for detection of ACD in the Czech Republic.

The relationship between MTX pharmacokinetics (AUC or erythrocytic MTX) and pharmacodynamics (PASI score) may exist. It is likely that the efficacy of psoriasis therapy with MTX could be improved by adjusting the dose according to plasma concentrations obtained after the first MTX administration.

There is a greater likelihood of developing other allergic diseases in atopic dermatitis patients who suffer from sensitisation to animal dander, mites, and dust. Thus, prompt management of atopic dermatitis and allergy to inhallant allergens that develop in early infancy may be a successful method for preventing of atopic march.

Results of this pilot trial show that the steady-state levels of MTXPGs in RBC vary less than threefold between patients and did not correlate with the change in PASI observed after 4 months of therapy with an individualised weekly dose of MTX. Whether pharmacokinetically guided dosing can improve the results of psoriasis therapy with MTX should be prospectively tested in large controlled studies.