Therapeutic Response and Adverse Effects of Methotrexate in Korean Patients with Dermatological Diseases

Kim, Young Jee; Yun, Sook Jung; Lee, Jee Bum; Kim, Seong Jin; Won, Young Ho; Lee, Seung Chul

Abstract

BACKGROUND
Methotrexate (MTX) is a synthetic folic acid analogue with anti-proliferative and anti-inflammatory properties, and is prescribed for a variety of dermatological disorders.
OBJECTIVE
The aim of this study was to investigate the therapeutic responses, adverse effects, and risk factors of MTX for dermatological use.
METHODS
We retrospectively evaluated age, gender, underlying diseases, initial and cumulative doses of MTX, treatment duration, physician's global assessment (PGA) scores, and adverse effects in 200 dermatological patients treated with MTX.
RESULTS
Various dermatoses responded to MTX in the following order of effectiveness: psoriasis vulgaris, pustular psoriasis, pityriasis lichenoides, atopic dermatitis, mycosis fungoides, and morphea. Adverse effects of MTX were observed in 64 of the 200 patients (32%) as follows: elevated liver function tests (LFTs) in 36 (18%), nausea or vomiting in 22 (11%), complete blood count abnormalities in 5 (2.5%), and a burning sensation over the lesion in 4 (2%). All patients who showed abnormal LFTs were normalized after reducing or stopping MTX, and the mean time to normalization was 5.76 weeks. Liver fibrosis was not found. Risk factors for MTX-related adverse effects were old age (p=0.028), skin disease (p=0.018), high initial dose of MTX (p=0.023), and high cumulative dose of MTX (p=0.044).
CONCLUSION
Among various dermatoses, psoriasis showed an excellent response to MTX with relatively acceptable safety in Koreans, but regular monitoring of MTX-related adverse effects is important. The risk factors for MTX-related adverse effects were old age, psoriasis, high initial dose, and high cumulative dose.