Background: Low-dose methotrexate (MTX) has been shown to be effective in the treatment of systemic sclerosis. Objective: We evaluated the effect of low-dose MTX on widespread morphea in a 24-week trial. Methods: Oral MTX, 15 mg/week, was administered to nine patients. Clinical records (modified skin score [MSS], durometer score, and the scores on a visual analogue scale (VAS) of feelings of tightness and itching), as well as laboratory data were examined. Serum aminoterminal propeptide of type III procollagen (PIIINP) was determined at weeks 0, 12, and 24. Results: At the end of the 24-week treatment period, significant improvement was observed in MSS (P = .01) and the VAS score for tightness (P < .01), whereas the durometer score (P = .07) and the VAS for itching (P = .07) showed a tendency toward improvement. PIIINP level did not alter. No serious adverse events were noted. Conclusion: These results suggest a beneficial effect of MTX on widespread morphea. Because spontaneous improvements are not uncommon, prospective double-blind, placebo-controlled studies are necessary to determine the usefulness of MTX in this disease. (J Am Acad Dermatol 1998;39:220-5.)