[Value of methotrexate in a case of florid cutaneous sarcoidosis]

The effectiveness of methotrexate against cutaneous sarcoidosis lesions resistant to corticosteroids or synthetic anti-malarial drugs has been reported by a few authors, and it is confirmed by the following case-report. A 54-year old woman had been suffering from sarcoidosis since 1977. Most of the lesions affected the skin and consisted of a very large plaque over the forehead and lesions on the elbow, forearm and knee. She also had Löfgren's syndrome stage II and Perthes-Jüngling osteitis. The highly inflammatory and extensive features of these lesions, and the patient's plea for treatment justified a systemic therapy. A first 4-day course of methylprednisolone succinate given as intravenous bolus injection was remarkably effective with collapse of the skin lesions, but these recurred about 4 months later. A second 4-day course of methylprednisolone was followed by an oral combination of mepacrine and chloroquine. Four years later, reactivation of the lesions required another course of corticosteroids given intravenously, then orally for a long time, but the use of these drugs in doses exceeding 30 mg per day, the poor results obtained and the appearance of diabetes mellitus made it necessary to discontinue this treatment. The patient was then put on methotrexate 10 mg per week. After 13 months, the results were dramatic, and the improvement observed has remained progressive and persistent. The drug was well tolerated, both clinically and biochemically. Although the skin lesions of sarcoidosis are innocuous, a treatment is indispensable in view of the major cosmetic damage inflicted on the patient.(ABSTRACT TRUNCATED AT 250 WORDS)