Methotrexate therapy for psoriasis. Guideline revisions

Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity

“…Treatment guidelines on the use of MTX in psoriasis have been published by Roenigk et al in 1973Roenigk et al in 1 , 1982Roenigk et al in 2 1998 and updated by a group of experts from the United States National Psoriasis Foundation in 2009. 4 Although considerable experience has accumulated on the use of MTX in psoriasis, there is still controversy regarding route of administration (subcutaneous vs. oral dosing), initial dosing and escalation, role of folic acid supplementation to improve tolerability.…”

Methotrexate induced chronic hepatotoxicity

“…2 Many studies conducted earlier, in methotrexate treated psoriatic patients reported a very high prevalence of hepatotoxicity with fibrosis occurring in up to 50% and cirrhosis in up to 20 %. 3,4 Concerns on hepatotoxicity in psoriasis patients, laid to dermatologic guidelines that indicate monitoring periodically after every 1500 mg cumulative dose, in order to identify liver injury by means of serial liver biopsies. Liver biopsy is regarded as the gold standard method in the assessment of histological changes, but its application is complicated by some important limitations.…”

An unusual case of acute methotrexate toxicity manifesting as ulcers on psoriatic plaques in an elderly male

“…3 Treatment guidelines on the use of MTX in psoriasis have been published by Roenigk et al in 1973, 4 1982, 5 1998 6 and updated by a group of experts from the United States National Psoriasis Foundation in 2009. 7 Absolute or relative overdose of methotrexate can result in acute toxicity, manifested clinically by myelosuppression, mucosal ulceration (especially oral), and rarely cutaneous necrolysis.…”