Prurigo nodularis: retrospective study of 13 cases managed with methotrexate.
BACKGROUND
Prurigo nodularis (PN), or nodular prurigo, is a chronic, debilitating, inflammatory skin disease. It can be very difficult to manage, and represents a challenge for the physician. Methotrexate (MTX) is a safe folic acid antagonist widely used in the management of inflammatory skin diseases such as psoriasis. Weekly administration of 7.5-20 mg methotrexate (low-dose methotrexate, LD-MTX) represents an attractive treatment option, and could therefore find a place in the management of PN.


OBJECTIVE
To evaluate the efficacy of LD-MTX as a treatment option for PN.


METHODS
Thirteen patients who had failed to respond to conventional therapies such as topical steroids, phototherapy and antipruritic agents were treated with LD-MTX. The mean age of the patients was 75.83. Objective symptoms (Prurigo Nodularis Area and Severity Index; PNASI) and subjective symptoms (Pruritus Numeric Rating Scale; PNRS) were recorded. Treatment consisted of one subcutaneous injection of MTX 7.5-20 mg once weekly for a minimum of 6 months. Adjuvant application of emollients and topical steroids was maintained where needed.


RESULTS
There was remission or marked improvement (decrease in both PNRS or PNASI of > 75%) in 10 cases, a trend to improvement in 2 cases and relapse in 1 case after treatment discontinuation.


CONCLUSIONS
LD-MTX may allow improvement of PN in some patients, with long-lasting remission.
Dermatology Clinic, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
P
P
Spring
I
I
Gschwind
M
M
Gilliet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004643:Emollients / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011536:Prurigo / Q000188:drug therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use
D003879:Dermatologic Agents; D004643:Emollients; D013256:Steroids; D008727:Methotrexate