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Methotrexate for psoriasis

M J Boffa¹, R J Chalmers

¹Dermatology Centre, University of Manchester School of Medicine, Hope Hospital, UK.

Clinical and Experimental Dermatology

|November 1, 1996

Summary

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Methotrexate is a cost-effective systemic treatment for severe psoriasis, including pustular psoriasis and psoriatic arthritis. While generally safe, potential risks like myelosuppression and liver fibrosis require careful monitoring, especially in vulnerable patients.

Area of Science:

Dermatology
Pharmacology

Background:

Methotrexate has been a cornerstone systemic therapy for severe psoriasis since the 1960s.
It is particularly indicated for acute generalized pustular psoriasis, psoriatic erythroderma, psoriatic arthritis, and extensive chronic plaque psoriasis unresponsive to topical treatments.

Purpose of the Study:

To review the efficacy and safety profile of methotrexate as a systemic treatment for severe psoriasis.
To discuss its role in managing various forms of severe psoriasis and highlight potential adverse effects.

Main Methods:

Review of existing literature on methotrexate for psoriasis treatment.
Analysis of its comparative effectiveness, cost-effectiveness, and safety profile against other systemic agents like cyclosporine, retinoids, and PUVA.
Evaluation of potential side-effects, including myelosuppression and liver fibrosis.

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Main Results:

Methotrexate is an inexpensive and effective option for severe psoriasis, offering favorable safety with correct use compared to other systemic therapies.
It serves as a valuable short-term option for unstable psoriasis and a common long-term maintenance treatment.
Key risks include acute myelosuppression (more likely in elderly, renal impairment, folate depletion) and long-term liver fibrosis (dose-related, exacerbated by hepatic toxins like alcohol).

Conclusions:

Methotrexate remains a vital systemic agent for severe psoriasis, balancing efficacy with cost-effectiveness.
Careful patient selection and monitoring are crucial to mitigate risks of myelosuppression and liver fibrosis.
Its role in psoriasis management, from acute flares to long-term control, is well-established, though direct comparative trials with all other systemic agents are limited.