PubMed · 14655770
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Jeffrey M Weinberg. 2003. Learning curve.. https://pubmed.ncbi.nlm.nih.gov/14655770/
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Methotrexate is a good treatment for severe psoriasis. Low-dose, once a week treatment is safe if guidelines are followed. Hematologic toxicity occurs especially if other drugs are associated. Hepatic cumulative toxicity is the main limiting factor for use. Compared with other systemic treatments of psoriasis, the low cost, efficiency and well known adverse effects, are still favorable to methotrexate.
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A 61-year old female patient with cutaneous sarcoidosis was treated with fumaric acid esters (Fumaderm). After 12 months of therapy, lesions were markedly improved and treatment was discontinued. 18 months later, the cutaneous lesions recurred, angiotensin converting enzyme (ACE) serum levels were increased and a chest X-ray demonstrated pulmonary involvement. Therapy with fumaric acid esters was again started. The skin showed improvement after 2 months and completely cleared within 17 months, within 4 months ACE levels normalized, and within 10 months radiologic changes markedly resolved. This case demonstrates a possible role for fumaric acid esters not only in the treatment of cutaneous but also systemic sarcoidosis.