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Related Experiment Videos

Methotrexate-induced epidermal necrosis.

P V Harrison

    The British Journal of Dermatology
    |June 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Erythrodermic psoriasis patients may face epidermal necrosis from methotrexate, especially with impaired kidney function and concurrent salicylate use. This severe reaction appears linked to elevated methotrexate levels, suggesting a dose-dependent risk rather than an unpredictable side effect.

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    Area of Science:

    • Dermatology
    • Pharmacology
    • Toxicology

    Background:

    • Erythrodermic psoriasis is a severe, widespread form of psoriasis.
    • Methotrexate is a common systemic treatment for psoriasis.
    • Epidermal necrosis is a rare but serious adverse event associated with methotrexate therapy.

    Observation:

    • A patient with erythrodermic psoriasis developed epidermal necrosis following methotrexate treatment.
    • The patient was also receiving concurrent salicylate administration.
    • The patient had borderline renal failure, which can impair drug elimination.

    Findings:

    • Concurrent salicylate use and renal impairment interfered with methotrexate elimination.
    • This led to significantly elevated plasma methotrexate concentrations 36 hours post-administration.

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  • The case suggests epidermal necrosis may be a dose-related adverse effect of methotrexate.

    • Implications:

    • Clinicians should exercise caution when prescribing methotrexate to patients with risk factors for impaired elimination, such as renal insufficiency and concurrent salicylate use.
    • Monitoring plasma methotrexate levels may be crucial in patients at risk.
    • This finding challenges the notion of epidermal necrosis as purely idiosyncratic, highlighting potential dose-related toxicity in methotrexate therapy.