Methotrexate is a safe and effective treatment for paediatric discoid (nummular) eczema: A case series of 25 children

Roberts, Hugh; Orchard, David

doi:10.1111/j.1440-0960.2010.00634.x

Cited by 36 publications

(27 citation statements)

References 12 publications

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“…Two retrospective studies of MTX for severe discoid (nummular) eczema have shown similar rates of improvement. Roberts et al reported that 84% of 25 children with discoid eczema were clear or almost clear at an average of 10.5 months (range 3–30 months) of MTX treatment (10 mg/week). Knopfel et al found that 82% of 28 children with discoid eczema were clear or had marked improvement after MTX (0.2–0.5 mg/kg/week) for a mean (±standard deviation (SD)) duration of 12.6 (+3.3) months.…”

Section: Discussionmentioning

confidence: 99%

Long‐term effect of methotrexate for childhood atopic dermatitis

Purvis

Lee

Agnew

et al. 2019

J Paediatrics Child Health

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Aim To evaluate methotrexate (MTX) for paediatric atopic dermatitis (AD) while on and post‐treatment. Methods Medical records of children prescribed MTX for AD between 2011 and 2016 at Starship Children's Hospital, Auckland, New Zealand, were reviewed for demographics, dose and duration of MTX and hospitalisations for AD. In the follow‐up by telephone in 2017, parents of the patients reported response on MTX, AD relapses and use of additional systemic treatment and completed a patient‐oriented eczema measure (POEM). Results Forty‐three patients aged 2–16 years were included. Four (9%) had previous systemic treatment, and 14 (33%) were hospitalised (28 admissions). MTX was given at median dose of 0.33 mg/kg (interquartile range (IQR) 0.26–0.40) for a median of 17 months (IQR 7.5–20). After initiating MTX, only six (14%) were hospitalised (nine admissions). Thirty (70%) parents of patients were followed up for a median of 29 months (IQR 14–45) after discontinuing MTX. Five (17%) reported ‘no change’, 2 (7%) ‘slightly better’ and 23 (77%) ‘a lot better’ AD on MTX. Of the 25 who responded to MTX, AD relapsed in 10 (40%) at a median of 24 months post‐MTX; only four (16%) restarted MTX. Median POEM at follow‐up was 6 (IQR 1–17). Eleven (37%) were clear (POEM 0–2), 11 (37%) had mild to moderate AD (POEM 3–16), and 8 (27%) had severe AD (POEM ≥17). Conclusions Although a natural resolution cannot be excluded, MTX for severe AD was effective and well tolerated. Improvement was reported by 83%, and AD hospitalisation reduced by half. At a median of 2 years after discontinuing MTX, one third were clear, and one third had mild to moderate AD, suggesting persistence of benefit post‐MTX.

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Section: Discussionmentioning

confidence: 99%

Long‐term effect of methotrexate for childhood atopic dermatitis

Purvis

Lee

Agnew

et al. 2019

J Paediatrics Child Health

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“…The use of MTX in children and adolescents for dermatologic and rheumatologic conditions has little or no effect on pulmonary, renal, dermatologic, developmental or cardiac systems 29. Long-term effects are not reported.…”

Section: Methotrexatementioning

confidence: 98%

Non-topical management of recalcitrant paediatric atopic dermatitis

Chong

Koh

2017

Arch Dis Child

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Atopic dermatitis (AD) is a common chronic, pruritic skin disease in children. As the incidence of AD increases, especially in high-income countries, paediatricians may see an increasing number of recalcitrant AD cases in their practice. Although these cases are principally managed by paediatric dermatologists, it is important for paediatricians to be aware of the use and side effects of non-topical treatment like phototherapy and systemic agents as well as the evidence for alternative treatment, which caregivers may ask about. This review presents paediatric evidence for the practical use of phototherapy and certain oral immunosuppressants for paediatric AD including doses, duration of use and monitoring of adverse effects. The use of alternative therapy including traditional medicine, probiotics and the role of nutrition are also discussed. Narrow band ultraviolet B phototherapy is effective in recalcitrant paediatric AD. When phototherapy is ineffective or contraindicated, systemic drugs may be administered cautiously with close surveillance of side effects. The use of azathioprine, ciclosporin, methotrexate and mycophenolate mofetil is generally safe in the short term under close monitoring and can be effective alongside compliance to topical treatment. Alternative complementary treatment is not known to be effective. Holistic management including therapeutic patient education is important. Good quality paediatric studies for non-topical AD treatment are needed for definitive guidelines.

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“…14 In children, the safety of MTX is well-established in juvenile rheumatoid arthritis and neoplastic diseases, and more recently in childhood discoid eczema. 15 Our own experience with low-dose MTX in childhood LyP, albeit in only two children, has so far been promising for persistent disease with cosmetically-significant scarring. MTX induced rapid resolution of persistent lesions and led to a decline in recurrences, although it did not induce permanent remission or change the natural course of the disease.…”

Section: Case Reportmentioning

confidence: 98%

Lymphomatoid papulosis in children: Experience of five cases and the treatment efficacy of methotrexate

Yip

Darling

Orchard

2011

Australasian Journal of Dermatology

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We present a case series of childhood lymphomatoid papulosis (LyP), an entity which is commonly misdiagnosed and poorly described in the paediatric dermatology literature. Clinically and histologically, the features of LyP in children can mimic insect bite reactions, with prominent dermal neutrophils and eosinophils. However, CD30 immunohistochemical staining of atypical lymphocytes within a mixed inflammatory infiltrate should point to the diagnosis of LyP. There is no consensus to guide management of childhood LyP due to its rarity and largely unknown natural course. We discuss our experience with LyP in five children and the use of methotrexate to induce rapid resolution of persistent lesions and to reduce recurrences in two children. Although none of our cases have experienced malignant transformation to date, life-long monitoring is advocated.

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Methotrexate is a safe and effective treatment for paediatric discoid (nummular) eczema: A case series of 25 children

Cited by 36 publications

References 12 publications

Long‐term effect of methotrexate for childhood atopic dermatitis

Long‐term effect of methotrexate for childhood atopic dermatitis

Non-topical management of recalcitrant paediatric atopic dermatitis

Lymphomatoid papulosis in children: Experience of five cases and the treatment efficacy of methotrexate

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