Postnecrotic cirrhosis of the liver developed in three nonalcoholic patients with psoriasis who were maintained on a long-term (11 to 40 months) regimen of orally administered folic acid antagonists. Portal hypertension with esophageal varices developed in two. The signs of cirrhosis developed insidiously and were not accompanied by signs of acute gastrointestinal or hematologic toxic conditions. There is a need for caution in the use of methotrexate in benign disease. A prospective study should be carried out to determine the best method of monitoring the hepatotoxicity of this drug during long-term administration.
Coe RO, Bull FE. Cirrhosis Associated With Methotrexate Treatment of Psoriasis. JAMA. 1968;206(7):1515-1520. doi:10.1001/jama.1968.03150070053008