Low-dose methotrexate administered weekly is an effective corticosteroid-sparing agent for the treatment of the cutaneous manifestations of dermatomyositis,☆☆

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Abstract

Background: The cutaneous manifestations of dermatomyositis can be the most prominent finding and are often difficult to treat. Objective: Our purpose was to determine whether low-dose methotrexate administered weekly in combination with other systemic therapies or as a sole systemic agent is effective in the treatment of the cutaneous disease in patients with dermatomyositis. Methods: We reviewed the records of 13 patients who received oral methotrexate in doses ranging from 2.5 to 30 mg weekly. Their skin lesions had not been completely responsive to sunscreens, topical corticosteroids, oral prednisone, oral antimalarial therapy, and, in one patient each, chlorambucil and azathioprine. Results: At the end of the study period, 4 of these 13 patients were free of all cutaneous manifestations of dermatomyositis, and another four had almost complete clearing. In the remaining five patients, methotrexate induced moderate clearing of their cutaneous lesions. In all patients, the addition of methotrexate allowed reduction or discontinuation of other therapies such as prednisone. All patients tolerated the methotrexate with minimal toxicity. Conclusion: Low-dose oral methotrexate administered weekly is effective in treatment of the cutaneous manifestations of dermatomyositis and frequently enables a reduction or discontinuation of corticosteroid therapy. (J Am Acad Dermatol 1997;36:67-71.)

Section snippets

PATIENTS AND METHODS

All charts of patients with a diagnosis of dermatomyositis from January 1988 to June 1994 were retrospectively reviewed. A total of 22 patients fulfilled at least three of the five diagnostic criteria proposed by Bohan and Peter. 10 To be included in this study we required that patients have cutaneous disease recalcitrant to other therapies and that they had been treated with methotrexate. Thirteen of the 22 patients met these inclusion criteria. The remaining nine patients had not been treated

RESULTS

Patient characteristics, maximal methotrexate dose, and previous treatments are listed in Table I . The mean age at presentation of the 13 patients was 48 years. Mild to moderate muscle disease was present in eight patients during the study, and the remaining five patients were free of muscle disease. Antimalarial therapy (eight patients) was discontinued when methotrexate was started. The maximal methotrexate dose varied from 2.5 to 30 mg per week. The average maximal dose was 7.5 mg per week.

DISCUSSION

The 13 patients in this study had clinical clearing (of varying degrees) of their cutaneous disease associated with dermatomyositis when low-dose methotrexate administered weekly was added to their treatment. Each patient had moderate to no muscle involvement and a cutaneous disease that had been unresponsive to prednisone and, in some cases, to antimalarials and azathioprine. In the nine patients taking prednisone at the time of initial therapy with methotrexate, tapering of the prednisone was

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