Methotrexate is an effective treatment for children with atopic dermatitis, psoriasis or psoriasis-eczema overlap. However, some patients may require dose modification to achieve complete response, according to results of a recently published study.

Syed I. Rahman, BA, of Saint Louis University School of Medicine, and colleagues published in the Journal of the American Academy of Dermatology a retrospective review of 46 patients aged 2 to 7 years (median 8 years) who were treated with methotrexate (MTX) for inflammatory skin diseases. The mean duration of treatment was 363 days, and 60% of children responded within three months.

Of those 46 children, 38 children achieved good to excellent response. Twenty-seven children achieved a good response within 12 weeks, and the remaining children achieved a desirable response after dose-adjustment, according to the researchers.

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Children with psoriasis/overlap had the highest responses (94%) noted as good to excellent compared with atopic dermatitis (77%). Mean maximum polyglutamate levels were 31.5 nmol/L for children who responded versus 18.1 nmol/L for patients who did not respond (P= 0.035).

Following dose modification, children considered late responders achieved a significantly higher mean maximum methotrexate polyglutamate assay (41.9 nmol/L) compared with those who did not respond (P=0.002). This difference was also significant for the subset with atopic dermatitis, Rahman and colleagues wrote, but not for patients with psoriasis-eczema overlap.

“MTX is an effective treatment for the majority of children with inflammatory skin diseases, but a subset requires dose modification to achieve good to excellent response. Methotrexate polyglutamate assay levels reflect response to treatment, but are most useful to support dose modification among children who fail to respond within 12 weeks,” the researchers concluded.


  1. Rahman SI. J Am Acad Dermatol. 2013;doi: 10.1016/j.jaad.2013.10.001.