title: Methotrexate toxicity presenting as ulceration of psoriatic plaques: a report of two cases.
abstract: We describe two cases of methotrexate toxicity occurring due to inappropriate self-medication with the drug. The first patient was a 57-year-old man with plaque-type psoriasis on intermittent methotrexate therapy. He discontinued his medications for 2 months and had exacerbation of psoriasis for which he self-medicated with methotrexate following which he developed ulceration of the psoriatic plaques accompanied by bone marrow suppression. The second patient was a 68-year-old man with chronic plaque-type psoriasis for 20 years and was being treated with intermittent methotrexate for 15 years. He also self medicated with oral methotrexate 15 mg daily for 7 days for exacerbation of psoriasis and developed ulceration of the psoriatic plaques with bone marrow suppression and evidence of gastrointestinal erosions.
authors.affiliation: Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Kishan Kumar
authors.initials: KK
authors.lastname: Agarwal
authors.forename: Amiya Kumar
authors.initials: AK
authors.lastname: Nath
authors.forename: Devinder Mohan
authors.initials: DM
authors.lastname: Thappa
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced / Q000175:diagnosis*; D012883:Skin Ulcer / Q000139:chemically induced / Q000175:diagnosis*
chemical_list: D008727:Methotrexate