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Year : 1997  |  Volume : 63  |  Issue : 5  |  Page : 307-309

Relapse in psoriasis after methotrexate

Correspondence Address:
N A Karibasappa

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Source of Support: None, Conflict of Interest: None

PMID: 20944362

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20 patients, 12 males and 8 females with chronic palque psoriasis, not responding to conventional therapy were treated with methotrexate (MTX) in the dose of 15 mg/week, 3 doses, 12th hourly apart, for 4 - 12 weeks. All the cases in which MTX was stopped after attaining remission and giving maintenance therapy of 5 mg/week for 8 weeks had relapsed within 6 weeks to 12 weeks. Premethotrexate or postmethotrexate laboratory investigations were within normal limits. No significant side effects were noted.

Keywords: Methotrexate, Relapse, Psoriasis

How to cite this article:
Karibasappa N A, George A. Relapse in psoriasis after methotrexate. Indian J Dermatol Venereol Leprol 1997;63:307-9

How to cite this URL:
Karibasappa N A, George A. Relapse in psoriasis after methotrexate. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2020 Aug 9];63:307-9. Available from:

  Introduction Top

Psoriasis is a chronic papulosquamous disorder of the skin of unknown etiology, characterised by a chronic relapsing nature and variable clinical features.[1] The selection of patient for methotrexate (MTX) therapy is based on indication relative to the severity of the disease, in contrast to the relative contraindication of the drug. Within these guidelines, the therapy of each patient must be individualized carefully to weigh benefit/ risk factor or the therapeutic index.[2] The use of methotrexate is indicated in the symptomatic control of recalcitrant psoriasis not responding to topical therapy. The patient should have severe psoriasis that may be life ruining physically, emotionally or economically.[3] The side effects and contraindications of MTX have been studied and are well known.[4]

From our country, there are only a few reports of use of MTX in psoriasis.[5] The effectiveness of MTX in psoriasis is well known, but chance of relapse after stopping MTX is not studied well. In the present study MTX was discontinued after achieving remission and observed for relapse in chronic plaque psoriasis.

  Materials and Methods Top

Twenty patients who had chronic plaque psoriasis involving more than 50% of the total surface of the skin and not responding to conventional therapy were selected. The exclusion criteria for methotrexate included significant abnormalities in liver and renal function tests, pregnancy and lactation, infertility, liver disorders, anaemia, excessive alcohol intake, acute infection, and non-compliance on the part of the patient to undergo regular treatment.

Premethotrexate investigation included complete haematological profile, hepatic and renal function tests, X-ray chest and test for blood sugar. During treatment, the hematological profile was repeated every week for the initial 4 weeks and subsequently every 2 weeks. Liver and renal function tests were repeated every 2 months. Clinical examination was done every week for the first 4 weeks and thereafter every 2 weeks. MTX was started in a weekly dose of 7.5 mg and increased to a maximum of 15 mg in 4 weeks. It was given in 3 twelve hourly doses. Response to treatment was evaluated clinically by observing the changes in erythema, scaling and clearance of skin lesions. On attaining clinical remission the dose of MTX was reduced and the patients were kept on maintenance dose of 5 mg per week for 8 weeks before stopping the treatment.

  Results Top

Out of 20 patients, there were 12 males and 8 females. Their age ranged from 21 to 53 years. The duration of psoriasis varied from 2 years to 23 years. The dosage was not increased beyond 15 mg/week as the response to treatment was adequate at this dose. The optimum dose for clearing of lesions varied from 25 mg to 167.5 mg. (average 100.2 mg). The time required for clearing varied from 4 weeks to 12 weeks (average 7.7 weeks). There was no relationship between duration of psoriasis, age of patient and the therapeutic response.

The minor side effects of therapy included nausea and or malaise in 9 patients, malaise and /or headache in 5 and nausea and abdominal discomfort in 3.

The time of relapse after stopping of treatment varied from 6 weeks to 12 weeks (average 8.9 weeks).

  Discussion Top

Treatment of psoriasis must always be appropriate to its severity and importance in that individual. It should not be more unpleasant, intolerable or dangerous than the disease itself.

The schedule of MTX treatment used in this study appears to have advantages compared to other schedules in that it has (1) lower total dose per week (2) clinical effectiveness comparable or better than other schedules and (3) minimal side effects. By careful patient selection and follow up, hepatic toxicity can be avoided.

How long MTX should be given, after subsidence of skin lesions is not known. In our present study, all the patients experienced relapse after discontinuing MTX after attaining remission. We now propose to keep the patients on maintenance treatment with a lower dosage for longer peiod or switching over to some other therapy after maintenance treatment.

  References Top

1.Farber EM, Wall M L. "Psoriasis" epidemiology, natural history and genetics In :Psoriasis, Edited by Roenigk H H, Maibach H I: Marcel Dekker, New York, 1985.  Back to cited text no. 1    
2.Peckam P E, Weinstein GD, Mc Cullough J L. The treatment of severe psoriasis: A national survey. Arch Dermatol 1987;123:1303-1307.  Back to cited text no. 2    
3.Roenigk H, Auerbach R, Maibach H. Methotrexate in psoriasis : Revised guidelines, J Am Acad Dermatol 1982;6:145-155.  Back to cited text no. 3    
4.Zachariae H. Methotrexate side effects. Br J Dermatol 1990;122:127-133.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Dhir R, Tutakne M, Chori K. Relapse in psoriasis after methotrexate. Int J Dermatol Venereol 1992;58:77-79.  Back to cited text no. 5    


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