Review of systemic methotrexate therapy in pediatric dermatoses

Abstract

Introduction: With increasing knowledge about limitations of systemic steroids, the use of steroid sparing agents is now being accepted by practicing dermatologists. Methotrexate (MTX) is a well accepted steroid sparing drug in adults with dermatological conditions. However, its use in pediatric dermatoses has not been the subject of many investigations. Materials and Methods: We decided to do a computerized search for the use of MTX in pediatric dermatoses using terms like pediatric,'' MTX, psoriasis,'' pityriasis rubra pilaris (PRP), atopic dermatitis, pityriasis lichenoides, lichen planus, juvenile dermatomyositis (JDMS), localized morphea, systemic lupus erythematosus (SLE), vesiculo-bullous diseases, alopecia areata, vasculitis, eosinophilic fasciitis, urticaria, sarcoidosis, pompholyx and vitiligo vulgaris. All the articles were retrieved and classified into review articles, studies, double-blinded trials and case reports. The final data were then analyzed. Results: It has been found that MTX has been increasingly used in psoriasis, PRP, pityriasis lichenoides, JDMS, SLE and sarcoidosis. However, its use in several other dermatoses is restricted to isolated case reports. Conclusion: Children tolerate MTX better than adults. However, proper clinical and laboratory surveillance has to be maintained in patients on long term MTX.