Methotrexate-induced epidermal necrosis.

IF 3.3

Clinical toxicology (Philadelphia, Pa.) Pub Date : 2025-08-12 DOI:10.1080/15563650.2025.2532616

Christopher Kennedy, John A Thompson

{"title":"Methotrexate-induced epidermal necrosis.","authors":"Christopher Kennedy, John A Thompson","doi":"10.1080/15563650.2025.2532616","DOIUrl":null,"url":null,"abstract":"Introduction: Methotrexate-induced epidermal necrosis is a rare, potentially fatal mucocutaneous reaction that clinically mimics Stevens-Johnson syndrome/toxic epidermal necrolysis. Early clinical manifestations include leukopenia, thrombocytopenia, mucositis and skin erosions. Risk factors for methotrexate-induced epidermal necrosis include age greater than 60 years, chronic kidney disease, and high initial dose of methotrexate (>10 mg/weekly) without folic acid supplementation.Case summary: A 63-year-old female with a history of psoriasis started taking oral methotrexate 10 mg weekly without folic acid supplementation and developed a desquamating rash covering more than 70% of her body. Her rash developed within two weeks of starting methotrexate. She received treatment with calcium folinate and made a full recovery.Images: Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.Conclusion: Methotrexate-induced epidermal necrosis is an uncommon, potentially fatal, adverse reaction to methotrexate. Early diagnosis of methotrexate-induced epidermal necrosis can prompt early intervention with calcium folinate and hopefully mitigate potentially fatal outcomes associated with methotrexate toxicity.","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-2"},"PeriodicalIF":3.3000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical toxicology (Philadelphia, Pa.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/15563650.2025.2532616","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Methotrexate-induced epidermal necrosis is a rare, potentially fatal mucocutaneous reaction that clinically mimics Stevens-Johnson syndrome/toxic epidermal necrolysis. Early clinical manifestations include leukopenia, thrombocytopenia, mucositis and skin erosions. Risk factors for methotrexate-induced epidermal necrosis include age greater than 60 years, chronic kidney disease, and high initial dose of methotrexate (>10 mg/weekly) without folic acid supplementation.

Case summary: A 63-year-old female with a history of psoriasis started taking oral methotrexate 10 mg weekly without folic acid supplementation and developed a desquamating rash covering more than 70% of her body. Her rash developed within two weeks of starting methotrexate. She received treatment with calcium folinate and made a full recovery.

Images: Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.

Conclusion: Methotrexate-induced epidermal necrosis is an uncommon, potentially fatal, adverse reaction to methotrexate. Early diagnosis of methotrexate-induced epidermal necrosis can prompt early intervention with calcium folinate and hopefully mitigate potentially fatal outcomes associated with methotrexate toxicity.

查看原文本刊更多论文

甲氨蝶呤诱导表皮坏死。

简介：甲氨蝶呤诱导的表皮坏死是一种罕见的、潜在致命的粘膜皮肤反应，临床上类似Stevens-Johnson综合征/中毒性表皮坏死松解。早期临床表现包括白细胞减少、血小板减少、粘膜炎和皮肤糜烂。甲氨蝶呤诱发表皮坏死的危险因素包括年龄大于60岁、慢性肾脏疾病和初始高剂量甲氨蝶呤（bbb10mg /周）而不补充叶酸。病例总结：一名63岁女性，有牛皮癣病史，开始每周口服甲氨蝶呤10mg，未补充叶酸，出现覆盖全身70%以上的脱皮皮疹。她的皮疹在开始服用甲氨蝶呤两周内出现。她接受了亚叶酸钙治疗并完全康复。影像：住院第二天的临床影像显示弥漫性皮肤糜烂和坏死。结论：甲氨蝶呤引起的表皮坏死是一种罕见的、可能致命的甲氨蝶呤不良反应。早期诊断甲氨蝶呤诱导的表皮坏死可以提示早期干预亚叶酸钙，并有望减轻与甲氨蝶呤毒性相关的潜在致命后果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical toxicology (Philadelphia, Pa.)

自引率

0.00%

发文量