Low-dose methotrexate-induced skin toxicity: Keratinocyte dystrophy as a histologic marker - 17/08/15
Abstract |
Background |
Skin toxicity during low-dose methotrexate therapy is rare, ill described, and reported to have nonspecific histologic characteristics. Thus, misdiagnosis is common in patients with mucosal ulcers and/or skin erosions related to low-dose methotrexate.
Objective |
We sought to describe the features of skin toxicity induced by low-dose methotrexate.
Methods |
We evaluated the clinical and histologic features in 5 patients who experienced skin toxicity induced by low-dose methotrexate between 2011 and 2013.
Results |
All 5 patients had acute mucosal ulcers, 4 had moderately abnormal blood cell counts, and 3 had skin erosions. In 3 patients, methotrexate dosage or dosing-schedule errors were identified. No other contributing factors (eg, renal dysfunction or interacting drugs) were identified. Mucocutaneous biopsy specimens consistently showed multiple dystrophic keratinocytes.
Limitations |
We studied only 5 patients and obtained no sensitivity or specificity data on the diagnostic value of keratinocyte dystrophy.
Conclusion |
Keratinocyte dystrophy may help to diagnose skin toxicity of low-dose methotrexate, even in the absence of known risk factors or methotrexate administration errors. Studies of the diagnostic performance of this histologic sign are needed.
Le texte complet de cet article est disponible en PDF.Key words : keratinocyte dystrophy, methotrexate, pancytopenia, psoriasis, skin toxicity, ulcers
Plan
| Drs Delyon and Ortonne contributed equally to this article. Drs Sbidian and Chosidow contributed equally to this article. |
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| Funding sources: None. |
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| Conflicts of interest: None declared. |
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| Reprints not available from the authors. |
Vol 73 - N° 3
P. 484-490 - septembre 2015 Retour au numéro
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