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A long-term methotrexate user with psoriasis developed new skin and oral lesions. Discontinuation of folic acid may have contributed to this adverse drug reaction.

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Area of Science:

  • Dermatology
  • Pharmacology

Background:

  • Psoriasis is a chronic autoimmune condition.
  • Methotrexate is a common immunosuppressant used for psoriasis treatment.
  • Folic acid supplementation is often recommended with methotrexate therapy.

Observation:

  • A 79-year-old female psoriasis patient presented with acute onset of widespread skin and oral mucosal eruptions.
  • The patient had been on weekly methotrexate (15 mg) for over 18 years.
  • Folic acid had been discontinued a few months prior to the eruption.

Findings:

  • The new-onset eruptions suggest a potential adverse reaction to methotrexate.
  • Methotrexate toxicity can manifest with mucocutaneous lesions.
  • Folic acid deficiency can potentiate methotrexate toxicity.

Implications:

  • This case highlights the importance of consistent folic acid supplementation in patients on long-term methotrexate therapy.
  • Awareness of potential methotrexate toxicity is crucial for early diagnosis and management.
  • Discontinuation of folic acid may increase the risk of adverse events in patients receiving methotrexate.