Main Article Content
antimetabolites, drug therapy, general dermatology, pityriasis rubra pilaris, methotrexate
Background: Pityriasis rubra pilaris (PRP) is a rare disease that is difficult to manage. Treatment options include corticosteroids, immunomodulatory drugs, and biologics. Available literature has primarily described the use of weekly dosing of methotrexate, but there is limited data investigating the effectiveness of daily low-dose methotrexate in PRP treatment.
Methods: A retrospective cohort study was conducted from September 2010 to December 2019 to determine the effectiveness of daily low-dose methotrexate in treating PRP.
Results: The average duration of follow-up was 13.5 months. 14 patients were treated with oral daily low-dose methotrexate. 13 patients (92.9%) showed improvement on oral daily low-dose methotrexate. Mean time to clinical response was 5.9 weeks. In seven patients (50%), complete response on methotrexate monotherapy occurred within an average of 11.9 months. 12 patients (85.7%) developed asymptomatic transaminitis that resolved in most patients (66.7%) after dose reduction.
Conclusions: In this study, daily low-dose methotrexate was an effective treatment of PRP and may be considered in patients unresponsive to weekly dosing. Due to the high incidence of transaminitis, the authors recommend frequent lab monitoring and screening for risk factors. Further studies are warranted to elucidate the efficacy of daily low-dose methotrexate in the management of PRP.
2. Knowles WR, Chernosky ME. Pityriasis rubra pilaris: prolonged treatment with methotrexate. Arch Dermatol. 1970;102(6):603-612.
3. Kromer C, Sabat R, Celis D, et al. Systemic therapies of pityriasis rubra pilaris: a systematic review. J Dtsch Dermatol Ges. 2019;17(3):243-259.
4. Ross NA, Chung HJ, Li Q, et al. Epidemiologic, clinicopathologic, diagnostic, and management challenges of pityriasis rubra pilaris: a case series of 100 patients. JAMA Dermatol. 2016;152(6):670-675.
5. Roenneberg S, Biedermann T. Pityriasis rubra pilaris: algorithms for diagnosis and treatment. J Eur Acad Dermatol Venereol. 2018;32(6):889-898.
6. Alazemi A, Balakirski G, AlShehhi F, et al. Juvenile pityriasis rubra pilaris: successful treatment with methotrexate. Clin Exp Dermatol. 2018;43(1):110-112.
7. Gemmeke A, Schönlebe J, Koch A, et al. Pityriasis rubra pilaris—a retrospective single center analysis over eight years. J Dtsch Dermatol Ges. 2010;8(6):439-444.
8. Koch L, Schöffl C, Aberer W, et al. Methotrexate treatment for pityriasis rubra pilaris: a case series and literature review. Acta Derm Venereol. 2018;98(5):501-505.
9. Brown J, Perry HO. Pityriasis rubra pilaris: treatment with folic acid antagonists. Arch Dermatol. 1966;94(5):636-638.
10. Parish LC, Woo TH. Pityriasis rubra pilaris in Korea: treatment with methotrexate. Dermatologica. 1969;139(6):399-403.
11. Anderson FE. Pityriasis rubra pilaris treated with methotrexate. Aust J Dermatol. 1966;8(3):183-185.
12. Chapalain V, Beylot-Barry M, Doutre MS, et al. Treatment of pityriasis rubra pilaris: a retrospective study of 14 patients. J Dermatol Treat. 1999;10(2):113-117.
13. Bath RK, Brar NK, Forouhar FA, et al. A review of methotrexate-associated hepatotoxicity. J Dig Dis. 2014;15(10):517-524.
14. Cline A, Jorizzo JL. Does daily folic acid supplementation reduce methotrexate efficacy? Dermatol Online J. 2017;23(11):13030/qt4hf5v2vk.
15. Radmanesh M, Rafiei B, Moosavi Z, et al. Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial. Int J Dermatol. 2011;50(10):1291-1293.
16. Beyer V, Wolverton SE. Recent trends in systemic psoriasis treatment costs. Arch Dermatol. 2010;146(1):46-54.
17. Wu J, Rastogi S, Menges B, et al. Comparison of the cost-effectiveness of biologic drugs used for moderate-to-severe psoriasis treatment in the United States. J Dermatol Treat. 2018;29(8):769-774.