Methotrexate: Role of Treatment in Skin Disease

Alex C. Holliday, MD; Megan N. Moody, MD, MPH; Alma Berlingeri-Ramos, MD


Skin Therapy Letter. 2013;18(3) 

In This Article

Abstract and Introduction


Methotrexate has been used for over half a century to treat a wide spectrum of skin conditions. It is a valuable steroid sparing agent, preventing protracted steroid courses and their undesirable side effects. While many alternative therapies exist and continue to emerge to treat these dermatologic conditions, the long history, affordability, and relative safety associated with methotrexate ensure its enduring utility. Further, ongoing research focusing on the pharmacogenetic properties of the drug may allow for more effective and targeted therapeutic strategies.


Dermatologists have employed the antineoplastic agent methotrexate (MTX, amethopterin) for over 6 decades to treat a variety of skin conditions (Table 1), most prominently psoriasis. MTX is often used as a steroid sparing agent in dermatologic patients requiring prolonged steroid courses. The long history of use chronicled in the literature elucidates MTX's efficacy, toxicity and relative safety, and portends to its ongoing utility. Recently, there has been a trend towards biologic therapy for several dermatologic conditions, placing the future of MTX treatment in jeopardy. However, MTX is significantly less expensive and novel studies in pharmacogenomics may allow a more personalized approach to its use. The following is a general review of MTX, focusing on its application in dermatologic diseases.