2016
DOI: 10.1590/abd1806-4841.20163960
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Abstract: Methotrexate is one of the most used drugs in the treatment of psoriasis with indication of systemic therapy. Cutaneous and mucous side effects are described by pharmacological characteristics of the drug itself or due to overdose. We report the case of a patient with ulcerations in oral mucosa and psoriatic plaques after incorrect use of Methotrexate. Prescribed in a weekly dose, it was used continuously for 10 days and without simultaneous intake of folic acid. It is important to ensure correct comprehension… Show more

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Cited by 13 publications
(8 citation statements)
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“…The clinical and histological characteristics of oral ulcers produced by MTX are not always diagnostic and an extensive clinicopathological investigation is necessary to exclude lymphoproliferative disorders; histopathological analysis has revealed a broad spectrum, ranging from non-specific ulceration, lichenoid reactions or lymphoproliferative disorders (2). Of the studies analysed in this literature review, only 7 (29.17%) performed a biopsy of the oral ulcer and the results were different: polymorphous lymphohistiocytic proliferation with atypical binuclear lymphocytes (2); area covered by exudate and regenerating epithelium, ectasia in proliferative vessels and neutrophils at the bottom of the lesion (5); regenerative basal layer with multinuclear keratinocytes (7); proliferation of large lymphoid cells with excised nuclei containing conspicuous nucleoli (17); atypical lymphocytic infiltrate with prominent nucleoli in submucosal granulation tissues (18); numerous proliferations of large atypical lymphoid cells with small lymphocytes (19); dense infiltrate composed of large lymphoid cells with irregular margins that occupy the entire thickness of the mucous membrane (20); and irregular and hyperplastic epithelial layers with apoptotic cells, atypical nuclei and a lichenoid appearance (21).…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…The clinical and histological characteristics of oral ulcers produced by MTX are not always diagnostic and an extensive clinicopathological investigation is necessary to exclude lymphoproliferative disorders; histopathological analysis has revealed a broad spectrum, ranging from non-specific ulceration, lichenoid reactions or lymphoproliferative disorders (2). Of the studies analysed in this literature review, only 7 (29.17%) performed a biopsy of the oral ulcer and the results were different: polymorphous lymphohistiocytic proliferation with atypical binuclear lymphocytes (2); area covered by exudate and regenerating epithelium, ectasia in proliferative vessels and neutrophils at the bottom of the lesion (5); regenerative basal layer with multinuclear keratinocytes (7); proliferation of large lymphoid cells with excised nuclei containing conspicuous nucleoli (17); atypical lymphocytic infiltrate with prominent nucleoli in submucosal granulation tissues (18); numerous proliferations of large atypical lymphoid cells with small lymphocytes (19); dense infiltrate composed of large lymphoid cells with irregular margins that occupy the entire thickness of the mucous membrane (20); and irregular and hyperplastic epithelial layers with apoptotic cells, atypical nuclei and a lichenoid appearance (21).…”
Section: Discussionmentioning
confidence: 99%
“…In blood, MTX is conjugated with albumin and excreted via the kidneys. Interaction with drugs that decrease the renal elimination of MTX, that inhibit the synthesis of folic acid or that decrease the binding of MTX to proteins can trigger adverse effects (5). Concomitant factors, such as old age, other drugs or kidney failure, can increase the toxicity of the drug (6).…”
Section: Introductionmentioning
confidence: 99%
“…It is an important side effect, because it is responsible for up to 10% of breaking treatment [7]. The cytotoxic effects of the drug are dose dependent and may also be associated with specific characteristics of each patient [19].…”
Section: Discussionmentioning
confidence: 99%
“…В другом клиническом случае были описаны множественные эрозии на слизистой оболочке щек, мягкого и твердого нёба у пациентки 58 лет, развившиеся в течение 3 сут после начала терапии МТ в дозе 10 мг/нед. с сопутствующим еженедельным приемом фолиевой кислоты в дозе 5 мг [19]. Среди 28 больных ревматоидным артритом, получавших низкодозовую терапию МТ, было выявлено 17 случаев оральной токсичности, проявившейся в виде эрозивно-язвенных поражений [16].…”
Section: клинические варианты нежелательных реакций в полости ртаunclassified