{"title":"甲氨蝶呤诱导表皮坏死。","authors":"Christopher Kennedy, John A Thompson","doi":"10.1080/15563650.2025.2532616","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Case summary: </strong>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.</p><p><strong>Images: </strong>Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.</p><p><strong>Conclusion: </strong>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.</p>","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":"{\"title\":\"Methotrexate-induced epidermal necrosis.\",\"authors\":\"Christopher Kennedy, John A Thompson\",\"doi\":\"10.1080/15563650.2025.2532616\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Case summary: </strong>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.</p><p><strong>Images: </strong>Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.</p><p><strong>Conclusion: </strong>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.</p>\",\"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}","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}
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.
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