Methotrexate-induced cutaneous ulceration without pancytopenia in a patient treated for inflammatory arthritis

Berna, Ronald; DaSilva, D.D.F.; Xu, Gang; Baumrin, Emily

doi:10.1016/j.jdcr.2021.05.024

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…These lesions usually occur within the first week of treatment, continue to evolve in the second week and last for 7-9 days. 18 A combination of topical steroid and antibacterial cream can be applied twice daily; and the oozing lesions improve substantially with potassium permanganate soaks (1:10,000). 19 to sit upright, take soft, semisolid diet in small portions, using straw for beverages, avoid hot, spicy and acidic food products, and take frequent sips of water.…”

Section: Drug Inactivationmentioning

confidence: 99%

“…A biopsy from the representative lesion may be taken to confirm the apoptotic changes with vacuolization. These lesions usually occur within the first week of treatment, continue to evolve in the second week and last for 7–9 days 18 . A combination of topical steroid and antibacterial cream can be applied twice daily; and the oozing lesions improve substantially with potassium permanganate soaks (1:10,000) 19 .…”

Section: Management Protocolmentioning

confidence: 99%

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Methotrexate toxicity in psoriasis—A multicentric retrospective study

Singh¹,

Sapra²,

Bahuguna³

et al. 2022

Dermatologic Therapy

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Even today methotrexate (MTX) remains the backbone of psoriasis management in dermatological practice. The widespread usage as well as over the counter availability of drug in India has led to frequent incidents of overdosing, resulting in toxicity. However, there is a lack of large size, comprehensive study in literature emphasizing upon reasons behind drug toxicity, clinical manifestations, and various management aspects.The present study aims to evaluate risk factors, clinical features, and suggest best management protocol based upon our experience in the management of MTX toxicity.A multicentric, retrospective study was conducted including all cases of psoriasis who were treated for MTX toxicity in the last 5 years. Complete information including demographic details, drug history, detailed clinical evaluation, laboratory parameters, management protocol, and outcome were studied and analyzed. A total of 21 patients of psoriasis with MTX toxicity were included, of which 20 had mucocutaneous ulcerations and hematological abnormalities were found in 76% patients. All cases were treated with folinic acid and 85% patients recovered within 7-14 days. Three out of 21 patients succumbed to their illness despite the best possible treatment. Overdosing was found to be the most common cause (66%) of drug toxicity, either inadvertent or due to self-medication. Patients must be counseled regarding course of the disease, drug regimen, and dreaded side effects prior to initiating the drug. In case the symptoms of toxicity appear, a prompt medical advice must be sought.

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Section: Drug Inactivationmentioning

confidence: 99%

Section: Management Protocolmentioning

confidence: 99%