Low-dose methotrexate administered weekly is an effective corticosteroid-sparing agent for the treatment of the cutaneous manifestations of dermatomyositis.
BACKGROUND
The cutaneous manifestations of dermatomyositis can be the most prominent finding and are often difficult to treat.


OBJECTIVE
Our purpose was to determine whether low-dose methotrexate administered weekly in combination with other systemic therapies or as a sole systemic agent is effective in the treatment of the cutaneous disease in patients with dermatomyositis.


METHODS
We reviewed the records of 13 patients who received oral methotrexate in doses ranging from 2.5 to 30 mg weekly. Their skin lesions had not been completely responsive to sunscreens, topical corticosteroids, oral prednisone, oral antimalarial therapy, and, in one patient each, chlorambucil and azathioprine.


RESULTS
At the end of the study period, 4 of these 13 patients were free of all cutaneous manifestations of dermatomyositis, and another four had almost complete clearing. In the remaining five patients, methotrexate induced moderate clearing of their cutaneous lesions. In all patients, the addition of methotrexate allowed reduction or discontinuation of other therapies such as prednisone. All patients tolerated the methotrexate with minimal toxicity.


CONCLUSIONS
Low-dose oral methotrexate administered weekly is effective in treatment of the cutaneous manifestations of dermatomyositis and frequently enables a reduction or discontinuation of corticosteroid therapy.
Kasteler
J S
JS
Division of Dermatology, University of Louisville, KY, USA.
Callen
J P
JP
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D002699:Chlorambucil / Q000008:administration & dosage / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003882:Dermatomyositis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D012074:Remission Induction; D012189:Retrospective Studies; D013473:Sunscreening Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000962:Antimalarials; D018906:Antineoplastic Agents, Alkylating; D003879:Dermatologic Agents; D004338:Drug Combinations; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019384:Nucleic Acid Synthesis Inhibitors; D013473:Sunscreening Agents; D002699:Chlorambucil; D001379:Azathioprine; D011241:Prednisone; D008727:Methotrexate