Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx

We describe 5 patients with severe pompholyx who did not respond to conventional therapy or who had debilitating side effects from corticosteroids. Low-dose methotrexate was added to their treatment regimens and led to significant improvement or clearing with a favorable side-effect profile. In all 5 patients the need for oral corticosteroid therapy was substantially decreased or eliminated, thus decreasing potential corticosteroid-induced morbidity. In this uncontrolled series of patients with recalcitrant palmoplantar pompholyx, methotrexate was an effective treatment and acted as a steroid-sparing agent.