Topical methotrexate therapy for psoriasis

Topically applied methotrexate is rapidly delivered into skin by fractional laser ablation

“…Topical AFXL-assisted application of MTX may have a potential to treat localized rheumatic and selected dermatologic disorders such as oligoarthritis [23], psoriasis [24,25], non-melanoma skin cancers [26], granuloma annulare [27] and morphea [28]. In oncology, high doses of 34 --345 mg MTX per week can induce systemic cytotoxicity, whereas for anti-inflammatory purposes MTX is currently administered orally or by a subcutaneous injection in doses of 10 --25 mg per week.…”

“…However, topical MTX delivery by other physical enhancement strategies including iontophoresis, microneedles, intracutaneous injections, diode laser and full-ablative Er:YAG laser has been studied in vitro in passive diffusion models [3][4][5]32,33] and in vivo in animals and humans [4,6,8,9,24,25,29]. In vitro studies generally reported lower skin deposition than the 10-fold increase by AFXL in our study, whereas one study of full-ablative Er:YAG laser demonstrated a maximum 19-fold increased MTX concentration in skin [3].…”

“…In vivo studies in mice [4,6,8] and patients [6][7][8][9][10]24,25,[34][35][36] demonstrated that the topical application of MTX was welltolerated locally without systemic adverse effects. However, investigations on the topical efficacy of MTX have expressed conflicting results and it is considered whether systemic administration of the drug is required in order to mediate the local effect.…”

Management of Psoriasis Vulgaris with Methotrexate 0.25% In a Hydrophilic Gel: A Placebo-Controlled, Double-Blind Study

“…), drug interactions, bioavailability, antioxidants, and a drug-compatible preservative. Topical methotrexate therapy for psoriasis had been reported in literature 16,17 long ago. However, because it was not pursued and no one was able to develop a clinically effective cream or gel formulation, topical methotrexate therapy never materialized.…”

Design and optimization of topical methotrexate loaded niosomes for enhanced management of psoriasis: Application of Box–Behnken design, in-vitro evaluation and in-vivo skin deposition study

“…Successful remedies for psoriasis lead to skin with a clinically normal state, i.e., resolution of epidermal thickness and reduced numbers of inflammatory cells (Zaba et al, 2007). The currently available topical treatments for psoriasis that have been found to be effective include: coal tar, anthralin, corticosteroids, photochemotherapy and retinoids (Weinstein et al, 1989). Methotrexate (MTX) is an effective systemic cytotoxic drug for the treatment of extensive psoriasis.…”