Methotrexate-induced cutaneous ulceration in 3 nonpsoriatic patients: Report of a rare side effect

Dermatological changes associated with non-specific inflammatory bowel diseases – Crohn’s disease and ulcerative colitis

“…Changes of this type may appear at any stage of the therapy, and their formation results from the high sensitivity of rapidly dividing keratinocytes to the folic acid antagonist. There are also reports of methotrexate-induced photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme [64][65][66]. A number of lesions located in the oral mucosa are also observed, such as erosions, ulcerative stomatitis or mucositis.…”

“…Zmiany tego typu mogą się pojawić na każdym etapie terapii, a ich powstawanie wynika z dużej wrażliwości szybko dzielących się keratynocytów na działanie antagonisty kwasu foliowego. W piśmiennictwie można znaleźć także opisy przypadków indukowanej metotreksatem nadwrażliwości na światło, złuszczającego zapalenia skóry, zespołu Stevensa-Johnsona, toksycznej nekrolizy naskórka oraz rumienia wielopostaciowego [64][65][66]. Obserwuje się również wiele zmian zlokalizowanych na błonie śluzowej jamy ustnej, takich jak nadżerki, wrzodziejące zapalenie jamy ustnej czy uogólniony stan zapalny błony śluzowej jamy ustnej.…”

Classic Findings, Mimickers, and Distinguishing Features in Primary Blistering Skin Disease

“…42 On H&E, focal dermal-epidermal clefting and variable degrees of keratinocyte dystrophy (including full-thickness epidermal necrosis) are seen ( Figure 13). 40,42,43 A background of interface dermatitis and a mixed dermal inflammatory infiltrate with eosinophils may be present, which in some cases may be abundant. 40 Epidermal dysmaturation, nuclear pleomorphism, and atypical mitotic figures have also been reported.…”

“…40 Epidermal dysmaturation, nuclear pleomorphism, and atypical mitotic figures have also been reported. 43 Helpful features favoring MTX toxicity versus TEN include especially severe mucositis (including involvement of the gastrointestinal tract with symptoms such as dysphagia and diarrhea), concomitant cytopenia(s), and acute renal insufficiency. 40 Neutropenic fever may be seen but typically follows the onset of cutaneous manifestations, 40 whereas the flulike prodrome of TEN precedes the rash.…”

Erosions of Psoriatic Plaques Due to Methotrexate

“…Erosions due to methotrexate can occur in psoriatic and non-psoriatic patients. [1][2][3][4] This rare side effect can precede pancytopenia and drug discontinuation is crucial. 1,2 As methotrexate is stored in the cells, serum levels are unreliable and rescue measures with folinic acid should be initiated regardless of drug blood levels.…”