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Published Online, 19 December 2007, www.theannals.com, DOI 10.1345/aph.1K271.
 The Annals of Pharmacotherapy: Vol. 42, No. 1, pp. 138-141. DOI 10.1345/aph.1K271
© 2008 Harvey Whitney Books Company.
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Methotrexate-Induced Papular Eruption Following Treatment of Psoriasis

Amel Mebazaa, MD

Department of Dermatology, Farhat Hached Hospital, Sousse Tunisia

Nesrine Kenani

Resident, Department of Dermatology, Farhat Hached Hospital

Mohamed Denguezli, MD

Professor, Department of Dermatology, Farhat Hached Hospital

Chaker Ben Salem, MD

Department of Pharmacology, Farhat Hached Hospital

Sonia Ziadi, MD

Department of Pathology, Farhat Hached Hospital

Badreddine Sriha, MD

Professor, Department of Pathology, Farhat Hached Hospital

Colandane Belajouza, MD

Department of Dermatology, Farhat Hached Hospital

Rafiaa Nouira, MD

Professor, Department of Dermatology, Farhat Hached Hospital

Reprints: Dr. Denguezli, Department of Dermatology, Farhat Hached Hospital, 4002 Sousse Tunisia, fax 21673226702, dr.denguezli{at}topnet.tn

OBJECTIVE: To report a case of a diffuse papular eruption following treatment of psoriasis with methotrexate injections.

CASE REPORT: A 52-year-old woman presented with an extensive flare of psoriasis associated with joint pain, especially in her knees and elbows. She was treated with intramuscular injections of methotrexate 20 mg/wk. Ten hours after the second methotrexate injection, the patient experienced a diffuse pruritic papular eruption located mainly on the limbs. Histology showed foci of dyskeratosis in the mucosal layer and a polymorphic perivascular inflammatory infiltrate of the papillary dermis, suggesting a drug-induced skin reaction. According to the Naranjo probability scale, the papular eruption was probably caused by methotrexate. The drug was discontinued and papular lesions gradually disappeared.

DISCUSSION: Methotrexate-induced papular eruption is rarely reported shortly after beginning methotrexate therapy in patients with acute exacerbation of collagen vascular diseases. Methotrexate-induced papular eruption following treatment of psoriasis has not been previously reported.

CONCLUSIONS: The pathogenesis of methotrexate-induced papular eruption in collagen vascular diseases may suggest cutaneous small-vessel vasculitis. In our patient, histology showed aspects of drug-induced skin reaction without vasculitis. Pathogenesis of methotrexate-induced papular eruption in psoriasis may involve immune mechanisms other than those of methotrexate-induced cutaneous vasculitis in collagen vascular disease.

Key Words: methotrexate, papular drug eruption, psoriasis

Published Online, December 19, 2007. www.theannals.com, DOI 10.1345/aph.1K271




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