Methotrexate (Rheumatrex?) is used dermatologically for the treatment of severe recalcitrant psoriasis; less commonly for the treatment of immune mediated bullous disorders and other conditions.


  • Pregnancy
  • Blood dyscrasia, cytopenia
  • Liver disease
  • Active infectious disease


  • Methotrexate therapy carries a very real risk of significant hepatic toxicity. Its use should be judged in relationship to the clinical problem, and to the risks and benefits of alternative therapy.
  • Toxicity can be enhanced by the use of concomitant medications such as aspirin, nonsteroidal anti-inflammatory agents, many antibiotics, and dilantin. Please consult your compendium.

Adverse effects:

  • GI discomfort, nausea
  • Elevation of liver enzymes
  • Many others. Please consult your compendium.


  • Psoriasis therapy is usually 2.5 mg every 12 hrs x 3, once each week for typical course of 6 weeks.
  • A liver biopsy is recommended prior to starting therapy.
  • Duration of therapy should be kept to a minimum.

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