Abstract
Since the earliest report 1 of the use of antimetabolites in the treatment of psoriasis, the secondary toxic manifestations have precluded their general acceptance. While there have been favorable comments on the use of aminopterin (4-aminopteroyl glutamic acid) in a few reports, 2-4 attention has also been drawn to the lack of responsiveness to low dose levels 5 and to the toxic effects of this drug when used in sufficiently high dosages. 6 Gastrointestinal toxicity was noted in 2 out of 3 patients first treated with aminopterin on this service. Hence, the application of other antimetabolites to the therapy of refractory psoriasis was undertaken. Mercaptopurine (6-mercaptopurine, Purinethol) is a synthetic analogue of adenine and of the purine base hypoxanthine. It is reported to interfere with nucleic acid biosynthesis. 7 There is one report of apparent failure of psoriasis to respond to a very limited course of therapy with the drug.
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