Cirrhosis Caused by Methotrexate in the Treatment of Psoriasis

Liver Damage due to Methotrexate in Patients with Psoriasis

“…In none of our patients, however, was there a history of alcoholism, and histological features of alcoholic hepatitis such as Mallory's hyaline, single-cell necrosis, and neutrophils were constantly absent. The changes observed are similar to those previously attributed to methotrexate both in osoriasis (O'Rourke and Eckert, 1964;Coe and Bull, 1968;Muller et al, 1969) and in otber conditions (Colsky et al, 1955;Hutter et al, 1960;Taft, 1965;Hersh et al, 1966;Talerman and Thompson, 1966).…”

“…Thou-gh folic acid antagonists were introduced in the treatment of psoriasis in the early 1950s (Gubner et al, 1951;Rees et al, 1955), it was not until 1964 that a psoriatic patient was first reported with liver disease attributable to methotrex- Muller et al, 1969;Epstein and Croft, 1969). Changes in hepatic histology attributed to folic acid antagonists have also been reported in leukaemia (Colsky et al, 1955;Hutter et al, 1960;Taft, 1965;Hersh et al, 1966;Talerman and Thompson, 1966;Sharp et al, 1969), histiocytosis X (Taft, 1965;Sharp et al.…”

Azathioprine in Treatment of Bullous Pemphigoid

“…Lever's conclusion, however, that methotrexate is the treatment of choice in most cases of bullous pemphigoid is open to criticism. There have been several disquieting reports (O'Rourke and Eckert, 1964;Ryan and Vickers, 1966;Coe and Bull, 1968;Muller et al, 1969) of renal and hepatic damage after methotrexate therapy in psoriasis. Results of histological examination of liver biopsy material from patients with psoriasis given methotrex-ate in conventional dosage suggest that about 50°% of patients who have had methotrexate for three years will have cirrhosis or sone degree of hepatic fibrosis (M. G. C. Dahl, M. M. Gregory, and P. J. Scheuer, 1970, personal communication).…”

Methotrexate Hepatotoxicity in Psoriasis--Comparison of Different Dose Regimens

“…Less severe abnormalities of liver histology were reported in patients treated for benign ocular disease (Hersh et al, 1966). Methotrexate has been used in the treatment of severe psoriasis for nearly 20 years, but although isolated reports of hepatic fibrosis and cirrhosis have appeared (O'Rourke and Eckert, 1964;Coe and Bull, 1968;Epstein and Croft, 1969;Muller et al, 1969;Dubin and Harrell, 1970) the relationship to methotrexate treatment has been disputed. Recently we have provided clear evidence of the hepatotoxic effects of methotrexate by finding hepatic fibrosis or cirrhosis in 17 (46%) out of 37 psoriatic patients and by showing that the severity of liver damage correlated well with the duration of treatment with methotrexate (Dahl et al, 1971).…”