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Treatment of Prurigo with Methotrexate
Prurigo is a common skin condition characterised by multiple nodules on the backs of the arms and legs that are extremely itchy. Treatment can be very challenging. Methotrexate is effective for the treatment of pruriginous dermatoses, but can it be used for prurigo?
A recent study published in the Journal of the European Academy of Dermatology and Venereology investigated the efficacy and safety of methotrexate in the treatment of difficult-to-treat prurigo.
Patients from six university dermatology departments treated with methotrexate between 2006 and 2016 for difficult‐to‐treat prurigo (that is, with failure to conventional therapies) were included in the retrospective multi-centre study. Patients with other pruritic dermatoses were excluded.
Clinical efficacy was recorded after three, six and 12 months of treatment via subjective efficacy (evaluation of the pruritus by the patient) and objective efficacy (assessment of cutaneous lesions by the physician).
Thirty‐nine patients with previous failure of topical steroids, H1‐antihistamine drugs or phototherapy were included. The average weekly dose of methotrexate was 15 mg. The average follow‐up time was 16 months.
The overall response rate was 91 per cent at three months, 94 per cent at six months, and 89 per cent at 12 months. Seven patients stopped methotrexate because of failure, and five because of the discovery of hepatocarcinoma, elevated transaminases, infectious pneumonitis or gastrointestinal symptoms.
The study concluded that methotrexate is a viable therapeutic option in difficult‐to‐treat prurigo.
Klejtman, T. , Beylot‐Barry, M. , Joly, P. , Richard, M. , Debarbieux, S. , Misery, L. , Wolkenstein, P. , Chosidow, O. and Ingen‐Housz‐Oro, S. (2018), Treatment of prurigo with methotrexate: a multicentre retrospective study of 39 cases. J Eur Acad Dermatol Venereol, 32: 437-440. doi:10.1111/jdv.14646
Interested in General Dermatology?
The HealthCert Professional Diploma of General Dermatology will teach you how to manage all major dermatological conditions in primary care. The courses are university quality-assured, CPD-accredited and count towards multiple Master degree pathways and clinical attachment programs in Australia and overseas. The program is delivered online.