Published: 2019-07-23

A study on the efficacy and adverse effects of methotrexate in psoriasis patients in a tertiary care centre

Yesodha S., Sujatha G., Arunkumar J.


Background: Psoriasis is a common, chronic and recurrent inflammatory disease of the skin. Methotrexate has been used in patient with psoriasis, a folic acid antagonist interfering with purine pathway and the mechanism of action in psoriasis is immune modulation and anti-inflammation. So, this study aims at monitoring the efficacy and adverse effects of methotrexate in south Indian patients with psoriasis attending a tertiary care hospital.

Methods: It is a prospective, observational study conducted for a period of one year in subjects of either sex having psoriasis. Methotrexate was initiated in a single weekly oral dose of 5mg to 25mg. The efficacy was evaluated using psoriasis Area and Severity Index (PASI) score in all patients before starting methotrexate therapy and the end of first month, third month and sixth month of therapy. Adverse reaction was monitored.

Results: All 40 psoriasis patients after treatment with methotrexate therapy showed improved  skin lesions by falling PASI scoring at the end of first, third and sixth month of treatment. None of the patients in our study had pulmonary toxicity, life threatening adverse effects which required hospitalization.

Conclusions: Use of methotrexate in the treatment of psoriasis in this study was found to be safe and highly efficacious and caused minimal adverse effects and it was well tolerated.


Adverse effects, Methotrexate, Psoriasis, Psoriasis Area and Severity Index Score

Full Text:



James, Berger, Elsten. Psoriasis. In: Andrews Diseases of the skin, Clinical Dermatology. 11th ed. Saunders, Elsevier; 2011:190-198.

Johann E. Gudjonsson & james T. Elder. Psoriasis. In: Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell, Klaus Wolff. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York, NY: McGraw Hill; 2012:197-231.

Baker H. Psoriasis: A review. Dermatology. 1975;150(1):16-25.

Lomholt G. Prevalence of skin diseases in a population, a census study from the Faroe Islands. Dan Med Bull. 1964;11:1-7.

Dogra S, Yadav S. Psoriasis in India: Prevalence and pattern. Ind J Dermatol, Venereol, Leprol. 2010;76(6):595-601.

Liu Y, Krueger JG, Bowcock AM. Psoriasis: Genetic associations and immune system changes. Genes Immun. 2007; 8(1):1-12.

Nickoloff BJ, Mitra RS, Varani J, Dixit VM, Polverini PJ. Aberrant production of interleukin-8 and thrombospondin-1 by psoriatic keratinocytes mediates angiogenesis. Am J Pathol. 1994;144(4):820-8.

Jeffrey P. Callen, Carol L, Kulp- Shorten, Stephen E. Wolverton. Methotrexate. In: Stephen E. Wolverton. Comprehensive Dermatologic Drug therapy. 2nd ed. Saunders, Elsevier; 2007:163-181.

Weinstein GD. Biochemical and pathophysiological rationale for amethopterin in psoriasis. Ann N Y Acad Sci. 1971;186(1):452-66.

Mitchell MS, Wade ME, Deconti RC, Bertino JR, Calabresi P. Immunosuppressive effects of cytosine arabinoside and methotrexate in man. Annals of internal medicine. 1969;70(3):535-46.

Berth‐Jones J, Grotzinger K, Rainville C, Pham B, Huang J, Daly S, et al. A study examining inter‐and intrarater reliability of three scales for measuring severity of psoriasis: Psoriasis Area and Severity Index, Physician's Global Assessment and Lattice System Physician's Global Assessment. Br J Dermatol. 2006;155(4):707-13.

Van de Kerkhof PC. On the limitations of the psoriasis area and severity index (PASI). British Journal of Dermatology. 1992;126(2):205-6.

Malik T, Ejaz A. Comparison of methotrexate and azathioprine in the treatment of psoriasis: a randomized controlled trial. J Pak Assoc Dermatol. 2016;20(3):152-7.

Ranjan N, Sharma NL, Shanker V, Mahajan VK, Tegta GR. Methotrexate versus hydroxycarbamide (hydroxyurea) as a weekly dose to treat moderate‐to‐severe chronic plaque psoriasis: A comparative study. J Dermatol Treat. 2007;18(5):295-300.

Van Dooren-Greebe RJ, Kuijpers ALA, Mulder J, Boo TD, van de Kerkhof PCM. Methotrexate revisited: Effects of long term treatment in psoriasis. Br J Dermatol. 1994;130(2):204-10.