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Updated: Jul 8, 2026

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Methotrexate and liver function: a study of 13 psoriasis cases treated with different cumulative dosages
S C Carneiro1, F F Cássia, F Lamy
1Sector of Dermatology and Post Graduation Course, HUCFF/URFJ and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Background:
The need and frequency of hepatic biopsies during methotrexate (MTX) therapy are still controversial.
Objectives:
The purpose of this investigation is to assess MTX liver toxicity in patients with psoriasis through percutaneous liver biopsy, and compare liver morphology changes with increasing cumulative dosages (1, 2, 3 and 4 g) of MTX.
Results:
Cumulative dosages of 1 to 2 g MTX did not cause significant liver toxicity. From a cumulative dosage of 3 to 4 g, there is fibrosis formation, inflammation enhancement in the portal area and fibrous septa, configuring regenerative nodes.
Conclusion:
In patients with no risk factors for liver disease, with normal physical examination and liver tests, biopsy can be done after a cumulative MTX dosage of approximately 1 to 1.5 g and repeated for each gram. In patients with risk factors, liver biopsy should be done before use of MTX, or within the first 2 months of treatment at the most, and repeated for each gram of cumulative dosage.
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