Intralesional methotrexate in dermatology: Diverse indications and practical considerations

Abstract

Intralesional methotrexate (IL‐MTX) is a long‐established treatment, which is arguably underutilized by dermatologists. We describe the underlying evidence base and practical considerations for its broad range of cutaneous indications, including in cutaneous oncology (keratoacanthomas, squamous cell carcinomas, lymphomas), inflammatory dermatology (nail psoriasis, plaque psoriasis, pyoderma gangrenosum, cutaneous Crohn's disease, amyloidosis), cutaneous infections (viral warts) and for treatment of filler complications. In certain circumstances, IL‐MTX can be more efficacious and less invasive than other treatments, with fewer adverse effects. Dermatologists should consider using IL‐MTX for a range of recalcitrant cutaneous conditions, particularly for those patients not amenable to surgery or systemic therapy.

Fractional CO2 Laser-Assisted Delivery Versus Intralesional Injection of Methotrexate in Psoriatic Nails

“…Localized injections of the drug may avoid the need for systemic medications in recalcitrant cases. 12 In a previous study by Mittal and colleagues, 3 the authors compared intramatricial injection of triamcinolone acetonide, methotrexate, and cyclosporine in 20 psoriatic patients. Among the 3 drugs, methotrexate yielded the best outcome with minimum side effects, and the results were comparable with triamcinolone acetonide.…”

Intralesional Methotrexate Versus Curettage and Application of 100% Trichloroacetic Acid in Planter Warts

“…If no improvement in the lesions was seen, the treatment was deemed unsuccessful. Adverse events were documented (9) .…”

Development and validation of a HPLC–UV based method for the extraction and quantification of methotrexate in the skin

“…Several treatment options exist, including surgical excision, Mohs surgery, radiotherapy, curettage followed by electrodessication and pharmacological treatments. Among these, intralesional methotrexate (MTX), widely used in oncology as an antitumoral agent, gives very promising outcomes against KA and in specified cases of SCC (Gualdi et al, 2020; Searle et al, 2021). Its mechanism of action includes the competitive inhibition of folic acid reductase enzyme, which is essential to supply methyl donor groups for DNA, RNA and protein synthesis, and blocking the production of thymidyl acid, which is essential for DNA synthesis and cell division.…”