Methotrexate toxicity presenting as cutaneous ulcerations on psoriatic plaques

Abstract

Methotrexate (MTX) is an effective but potentially toxic treatment for psoriasis. We describe a patient who administered 20 mg daily of MTX for 5 d and presented with ulcerated and necrotic lesions on the psoriatic plaques, mouth erosions and hair loss. However, his psoriatic plaques and ulcerations totally healed rapidly within two weeks and no recurrence has been observed for the 6 months of follow up.

Low-dose methotrexate-induced skin toxicity: Keratinocyte dystrophy as a histologic marker

“…Severe keratinocyte dystrophy was consistently found in the biopsy specimens. The diagnosis of methotrexate toxicity was supported by the similar clinical features to those reported previously [4][5][6][7][9][10][11][12][13][14] and by the blood cell count abnormalities indicating myelotoxicity. Furthermore, no other cause to the mucocutaneous abnormalities was found.…”

Localised and sustained intradermal delivery of methotrexate using nanocrystal-loaded microneedle arrays: Potential for enhanced treatment of psoriasis

“…Even though MTX Na shows a remarkable antipsoriatic effect and is more cost-effective than other therapies ( Cabello Zurita et al., 2017 ; Kim et al., 2017 ), its current administration routes and drug delivery systems are not so satisfactory. Systemic administration of MTX Na leads to prolonged high levels of systemic drug exposure, which are associated with many side effects, including gastrointestinal disturbances, such as nausea, vomiting and diarrhoea, hepatotoxicity, suppression of bone marrow function, dyspnoea, leukopenia, anaemia, thrombocytopenia and menstrual alteration ( Branco et al., 2016 ; Bianchi et al., 2016 ; Jacobse et al., 2019 ; Braun et al., 2008 ; Braun and Rau, 2009 ; Koçak et al., 2013 ; Boukhettala et al., 2009 ; Wang et al., 2018 ). Moreover, orally administered MTX Na suffers from first-hepatic metabolism and nonlinear pharmacokinetics, which affect its bioavailability, consequently its clinical efficacy ( Hoekstra et al., 2006 ).…”

Kutanöz Ülserler İle Seyreden Akut Metotreksat Toksi̇si̇tesi̇ / Acute Methotrexate Toxicity Presenting With Cutaneous Ulcerations

“…KEYWORDS: cutaneous ulceration, methotrexate, psoriasis Sayın Editör, Metotreksat, psoriaziste yaygın kullanılan ve haftalık 25 mg'yi aşmayan dozlarda göreceli olarak güvenli bir tedavidir (1). Metotreksatın iyi bilinen ve kronik kullanımı sırasında daha sık karşılaşılan dispepsi, hepatotoksisite ve miyelosupresyon gibi yan etkileri mevcuttur (2,3). Şiddetli akut toksisiteye nadiren rastlanır, klinikte psoriatik plaklarda ülserasyon ve nekroz şeklinde bulgu verir (4 Akut toksisitede psoriatik plakların ülserasyon ve nekrozu nadir görülen ancak karakteristik bir bulgudur (1).…”