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Mucocutaneous ulcerations secondary to methotrexate
Jennifer Warner1, Alissa Brown, S Elizabeth Whitmore
1Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Cutis
|June 12, 2008
Summary
Methotrexate (MTX) can rarely cause mucocutaneous ulcerations. A patient with psoriasis and psoriatic arthritis developed oral and skin ulcerations after an MTX dose increase, which resolved upon MTX discontinuation.
Area of Science:
- Dermatology
- Rheumatology
- Pharmacology
Background:
- Methotrexate (MTX) is a widely used medication across dermatology, rheumatology, and oncology.
- Drug-induced mucocutaneous ulcerations are a rare but potential adverse effect of MTX therapy.
Observation:
- A 36-year-old female patient with plaque psoriasis and psoriatic arthritis was treated with oral MTX and phototherapy (methoxsalen plus UVA).
- Following an escalation of the weekly MTX dosage, the patient presented with significant erosions and ulcerations affecting her oral mucosa and existing psoriatic lesions.
Findings:
- Discontinuation of MTX led to the complete resolution of all oral and cutaneous ulcerations within a two-week period.
- This case highlights a rare adverse reaction to methotrexate, specifically mucocutaneous ulcerations.
Implications:
- Clinicians should consider MTX-induced mucocutaneous ulcerations in patients presenting with such symptoms, especially after dose adjustments.
- Early recognition and discontinuation of MTX may be crucial for managing this adverse effect and facilitating healing.
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