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Toxic rash associated with high dose methotrexate therapy
R Bell1, J R Sullivan, J G Burdon
1Department of Haemato-Oncology, Royal Melbourne Hospital, Victoria, Australia.
Abstract:
Fifteen rashes were observed in thirteen patients in association with high dose methotrexate therapy. The lack of recurrence of the rash with further treatment courses and the association of the rash with other toxic manifestations and with larger doses of methotrexate suggests a toxic mechanism. Rashes have frequently been reported in association with dose methotrexate therapy (Van Scott, Auerbach & Weinstein, 1964; Leone, Albala & Rege, 1968; Mitchell et al., 1968; Capizzi et al., 1970; Jaffe et al., 1973; Rosen, Suwansirikul & Kwon, 1974; Pratt et al., 1975; Jaffe & Traggis, 1975; Ensminger & Frei, 1977; Stoller et al., 1977). They include perifolliculitis, transient erythema progressing to maculopapular eruptions, occasionally desquamating, sloughing over pressure areas, reactions confined to radiation portals, exacerbation of acne, photosensitivity and rarely urticaria. Relatively few reports sufficiently document the incidence or types of rash. It has been suggested that the rash is allergic in nature (Mitchell et al., 1968) or a toxic phenomenon (Djerassi et al., 1972; Djerassi & Kim, 1976), possibly related to drug effects on small vessels (Van Scott, 1963).
Insights
High-dose methotrexate therapy can cause various skin rashes in patients. These methotrexate-associated rashes appear to be toxic in nature, rather than allergic, and are linked to higher drug doses.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Methotrexate (MTX) is a chemotherapy agent used in various cancers and autoimmune diseases.
- Skin rashes are a frequently reported side effect of high-dose MTX therapy.
- The exact mechanism and incidence of MTX-induced rashes require further elucidation.
Purpose of the Study:
- To investigate the nature and potential mechanisms of skin rashes associated with high-dose methotrexate therapy.
- To document the types of rashes observed and their relationship to MTX dosage and toxicity.
Main Methods:
- Observational study of thirteen patients treated with high-dose methotrexate.
- Clinical documentation of observed skin rashes and associated toxic manifestations.
- Analysis of rash recurrence in relation to subsequent MTX treatment courses.
Main Results:
- Fifteen distinct rashes were observed in thirteen patients receiving high-dose MTX.
- The observed rashes included perifolliculitis, erythema, maculopapular eruptions, and desquamation.
- Rashes did not recur with subsequent MTX courses and were associated with other toxicities, suggesting a toxic mechanism.
Conclusions:
- The skin rashes associated with high-dose methotrexate therapy are likely a toxic phenomenon.
- The incidence and specific types of MTX-induced rashes warrant further investigation.
- Understanding the toxic mechanism can aid in managing MTX-related dermatological side effects.