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Abstract
Abstract—Methotrexate is a competitive folic acid inhibitor and interferes with DNA synthesis. Skin reactions from methotrexate are infrequent and highly varied, and may or may not be a sign of toxicity. We present two patients treated with 35 mg. a week of methotrexate, one for psoriasis and the other for rheumatoid arthritis, who developed mucous and skin lesions related to this drug. The patient with psoriasis also presented with erosion and bleeding of the psoriasis plaques and hepatic and hematologic toxicity. The histological changes suggested a cytotoxic effect from chemotherapy, and presented with a discrete vacuolar interface dermatitis with marked epidermal dysmaturation, cellular atypia and eccrine squamous syringometaplasia. In both patients, we interpreted the mucocutaneous lesions as a sign of toxicity from the drug.
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