Table 1-Cutaneous Eruptions due to Methotrexate 1-24
|
Eruptions linked to methotrexate |
Agent administered with Methotrexate/Comments |
Incidence if available |
Toxic/apoptic side effect |
|
Maculopapular eruption |
|
15% |
|
|
Folliculitis |
|
|
|
|
Acral Erythema |
Also referred to as Burgdorf's reaction |
|
yes |
|
Erythema multiforme |
|
|
yes |
|
Urticaria |
|
4% in psoriasis patients |
|
|
Radiation recall dermatitis |
|
|
yes |
|
Exacerbation of urticarial vasculitis |
|
|
maybe |
|
Reactivation of sunburn |
|
|
yes |
|
Photosensitivity |
|
5% |
maybe |
|
Vasculitis |
|
|
|
|
Severe skin rash |
Eruptions more severe than maculopapular eruptions and less severe then TEN |
|
yes |
|
Erythema |
UVB |
|
|
|
Erythema |
Independent of UVB |
|
|
|
Angioedema |
|
|
|
|
Toxic epidermal necrolysis (TEN) |
Use of trimethoprim-sulfamethoxazole (Bactrim) |
|
yes |
|
Toxic epidermal necrolysis |
Independent of Bactrim use |
|
yes |
|
Stevens-Johnson syndrome |
Acetylic salicylic acid, myelosuppression present |
|
yes |
|
Allergic reaction |
Unspecified |
|
|
|
Capillaritis |
|
|
|
|
Alopecia- telogen effluvium |
|
6% (low dose)-8% (high dose) |
|
|
Alopecia- anagen effluvium |
High dose methotrexate |
|
yes |
|
Horizontal pigmented bands developing within scalp hair |
|
|
|
|
Papular eruption in patients with rheumatic disease |
|
|
|
|
Accelerated nodulosis and vasculitis in rheumatoid arthritis ± Raynaud's phenomenon |
|
|
|
|
Oncholysis/onchomadesis |
|
|
|
|
Hyperpigmentation |
|
|
|
|
Alteration in nail pigment |
|
|
|
|
Type 1 erosions/ulcerations Erosions in psoriatic plaques with methotrexate use27,28 |
Can happen as the dose is increased or where renal clearance suddenly decreases (e.g. new NSAID use) |
|
likely |
|
Type 2 erosions/ulcerations, Skin ulcerations in non-psoriatic, but previously dermatitis altered skin (primarily on the legs due to stasis dermatitis). |
|
|
yes |
|
Unspecified type erosions Cutaneous ulceration on the knuckles |
|
|
yes |
|
Unspecified type erosions Erosions over pressure areas |
|
|
yes |
|
Ulcerative stomatitis |
Overdose of methotrexate |
|
yes |
|
Acne |
|
|
|
|
Furunculosis |
|
|
|
|
Oral ulcerations |
|
|
yes |
|
Reactivation of irritant dermatitis |
|
|
yes |
|
X-ray portal |
|
|
yes |
|
Severe stomatitis and skin rash |
Prior therapy with cis-diamminedichloride platinum (CDDP). Myleosupression, diarrhea, renal failure, hepatic toxicity present |
Death rate 6% |
yes |
|
Mucositis |
More common in high doses |
|
yes |