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Cutaneous ulceration caused by methotrexate
Dana W Kazlow1, David Federgrun, Stephen Kurtin
1Department of Dermatology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA.
Abstract:
Methotrexate has been associated with the development of skin ulceration in small numbers of patients with psoriasis. We describe a 58-year-old man with a 15-year history of plaque-type psoriasis. He had been treated with methotrexate therapy (15 mg orally per week for 32 weeks) and had ulcers develop within psoriatic plaques on both elbows, on the mucosal aspect of the lower lip, and in an appendectomy scar on the right lower quadrant of the abdomen. Ulcers healed upon discontinuation of methotrexate, but the scar eroded again upon reintroduction of methotrexate.
Insights
Methotrexate therapy can cause skin ulceration in some psoriasis patients. This case shows ulcers healing after stopping methotrexate, but recurring upon reintroduction.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Psoriasis is a chronic autoimmune skin condition.
- Methotrexate is a common immunosuppressive drug used to treat psoriasis.
Observation:
- A 58-year-old male patient with plaque psoriasis developed ulcers.
- Ulcers appeared on elbows, lower lip mucosa, and an appendectomy scar during methotrexate treatment.
Findings:
- Methotrexate-induced skin ulceration occurred in psoriatic plaques and scars.
- Ulcers resolved after discontinuing methotrexate.
- Scar erosion recurred upon methotrexate reintroduction.
Implications:
- Methotrexate requires careful monitoring for potential cutaneous side effects.
- Understanding drug-induced ulceration is crucial for patient management.
- This case highlights the importance of considering medication side effects in treatment decisions.