Oral Ulceration With Low Dose Methotrexate Therapy in a Psoriasis Patient: A Case Report

Abstract

Methotrexate (MTX) is a well established drug used in the treatment of various neoplastic diseases. The efficacy of MTX against rheumatic diseases was first demonstrated in the early 1950s when aminopterine, a precursor of MTX, was used for rheumatoid arthritis (RA). Recently it has been increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. As a consequence it is likely that dentists will encounter patients taking this drug in general dental practice. While certain adverse effects of low-dose methotrexate therapy have been described in detail, oral complications have received little attention. Ulceration in oral mucosa can occur as a side effect at any time during the course of methotrexate therapy. This may be due to lack of folic acid supplementation or overdosage due to confusion regarding its once-weekly regime. Even though adverse effects occur in oral cavity, potential still exists for specifically preventing and reversing its toxicity. Here, we are presenting a case report of low dose methotrexate therapy (LDMTX) induced oral ulceration in a patient suffering from Psoriasis. This article also summarises the uses and pharmacology of low-dose methotrexate and the mechanisms that lead to general and oral toxicity.