Ten to 30 mg weekly methotrexate (MTX) has long been used as a treatment for severe, recalcitrant psoriasis. However, some patients do not improve with those dose and there has been oral methotrexate scarcity period in Indonesia since 2015. This is the first study to evaluate the safety profile of high dose (50 mg weekly) MTX injection in severe psoriasis cases at Sardjito hospital, Yogyakarta. We conducted a retrospective adverse effects evaluation from demographic and laboratory data of 23 severe psoriasis patients who had received six weekly intramuscular injections of MTX. For the results, five (21.70%) patients developed hematological adverse effects, four (17.30%) patients developed hepatic adverse effects, and three (13.05%) patients developed renal adverse effects. Majority of the abnormal laboratory findings in this study were mild and transient. High dose MTX injection appears to be safe for severe psoriasis if proper patient baseline condition assessment was taken before starting therapy, all contraindications have been excluded, and is used under close supervision at high level medical facilities.

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