Methotrexate Reactivation of Sunburn Reaction

Korossy, Katalin S.

doi:10.1001/archderm.1981.01650050066027

Cited by 33 publications

(5 citation statements)

References 11 publications

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“…It may also inhibit local mononuclear cell responses to ultraviolet injury and thus augment local tissue damage. 12 The initiation of pellagra-like dermatitis in this patient, whose psoriasis was otherwise well controlled on methotrexate treatment, was clearly associated with the institution of haloperidol. Its resolution with high dose niacin and multivitamins indicates that haloperidol probably interacted with tryptophan metabolism, which was overcome by a high dose of niacin.…”

Section: Discussionmentioning

confidence: 74%

Delayed reactivation of haloperidol induced photosensitive dermatitis by methotrexate

Thami

Kaur

Kanwar

2002

Postgraduate Medical Journal

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A man whose psoriasis was well controlled on methotrexate treatment developed pellagra-like photosensitive dermatitis when he started taking haloperidol. Reactivation of his dermatitis was observed with methotrexate as a recall photosensitivity phenomenon. This false photosensitivity reaction of methotrexate is an important but rarely encountered adverse effect. A possible interaction between methotrexate and haloperidol is emphasised. M ethotrexate has been associated with a variety of cutaneous adverse reactions, of which recall or reactivation of acute sunburn response is a peculiar reaction. This has also been termed as a false photosensitivity reaction. [1][2][3][4] Methotrexate is also well known for its interaction with other drugs. Pellagra-like dermatitis, an adverse reaction of many cytotoxic drugs like 6-mercaptopurine, 5-fluorouracil, and azathioprine, however, has not been reported with the use of methotrexate.5 Although phenothiazines are commonly associated with photosensitivity, haloperidol, a closely related drug, has rarely been reported to induce photosensitivity. 6 CASE REPORTA 41 year old man had been taking weekly oral methotrexate (15 mg) for the past 10 months for psoriasis. Haloperidol 1.5 mg twice daily was then introduced for his psychotic illness. Two weeks after staring haloperidol, he presented with a sudden onset of redness and swelling of face and hands accompanied by redness and watering of both eyes. There were no other complaints, his food intake was normal, and he did not take alcohol or herbal medicines. He denied having excessive exposure to the sun in the recent past. His general physical and systemic examination was normal. His psoriasis was well controlled and he was applying emollients over a few well defined plaques of psoriasis.Examination revealed diffuse erythema, oedema, scaling, and erosions over his face, anterior aspect of the neck, and dorsa of both hands (fig 1). It was sharply demarcated to photoexposed areas with characteristic sparing of upper eyelid folds, retroauricular and submental areas. In addition, he had exfoliative cheilitis, angular cheilitis, diffuse oral mucositis, bilateral conjunctival injection, photophobia, and excessive lacrimation. A differential diagnosis of pellagra-like dermatitis precipitated by haloperidol, photosensitivity to haloperidol, exacerbation of psoriasis, and a possible interaction of haloperidol and methotrexate leading to photosensitive dermatitis was considered.The patient was hospitalised and investigations revealed a normal complete blood count, platelet count, urine analysis, and hepatic and renal function tests. A skin biopsy from the dorsum of the hand revealed parakeratosis, acanthosis, spongiosis, focal epidermal cell degeneration and dermal oedema, accompanied by a moderate lymphomononuclear infiltrate consistent with subacute dermatitis. A diagnosis of pellagralike photosensitivity dermatitis caused by a combined deficiency of niacin, riboflavin, and other water soluble vitamins probably precipitated by haloperid...

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Section: Discussionmentioning

confidence: 74%

Delayed reactivation of haloperidol induced photosensitive dermatitis by methotrexate

Thami

Kaur

Kanwar

2002

Postgraduate Medical Journal

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“…The pathomechanism of UV recall is poorly understood. It has been postulated that MTX inhibits anti‐inflammatory pathways; while this may be possible when there is a recent history of UV injury, this is unlikely when the initial insult occurred a long time ago as in our case 3 . A more likely possibility might be the presence of skin memory immune cells.…”

mentioning

confidence: 71%

Sequential Stevens–Johnson syndrome and photo‐recall phenomenon

Lee¹,

Philippidou²,

Marcus

et al. 2012

British Journal of Dermatology

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“…in terms of the erythematic response, previous studies report the "erythema recall phenomenon," in which mTX given 24 to 48 hours after uV-induced erythema caused an exacerbation of the erythema, often with more severe inflammation. 22,23 although all three studies reported mild cases of erythema, none reported evidence for the "erythema recall phenomenon." furthermore, no significant laboratory abnormalities were noted during the course of follow-up in any of the three studies.…”

Section: Discussionmentioning

confidence: 97%

A Review of the Efficacy and Safety of Combined Methotrexate and Ultraviolet B Phototherapy versus Ultraviolet B Phototherapy Alone in the Treatment of Psoriasis

2010

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Background Methotrexate (MTX) and ultraviolet light B (UVB) phototherapy are effective as single agents for psoriasis. By combining the two agents, it is proposed that the use of UVB-MTX can yield greater therapeutic efficacy than using MTX or UVB alone and limit the cumulative exposure of both UVB and MTX to the patient. Objective To review evidence on the clinical efficacy and safety of using combined UVB-MTX compared with using UVB alone. Methods We performed a PubMed search for studies involving the combination of UV therapy with MTX. The reported studies evaluate the clinical efficacy and safety of UVB-MTX therapy compared with UVB alone. Results Based on the studies we reviewed, combined UVB-MTX therapy is more effective than UVB alone in treating psoriasis. The mean cumulative MTX doses ranged from 112 to 196 mg, and no cases of MTX-related liver toxicity symptoms were reported in the three studies. Discussion Combination phototherapy involving UVB-MTX is more clinically effective than UVB alone for patients with plaque-type psoriasis. The current review is limited by the absence of studies comparing the efficacy of combined UVB-MTX therapy with MTX monotherapy. Combination UVB-MTX therapy appears to be safe and well tolerated.

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Methotrexate Reactivation of Sunburn Reaction

Cited by 33 publications

References 11 publications

Delayed reactivation of haloperidol induced photosensitive dermatitis by methotrexate

Delayed reactivation of haloperidol induced photosensitive dermatitis by methotrexate

Sequential Stevens–Johnson syndrome and photo‐recall phenomenon

A Review of the Efficacy and Safety of Combined Methotrexate and Ultraviolet B Phototherapy versus Ultraviolet B Phototherapy Alone in the Treatment of Psoriasis

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