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To the Editor.—
In answer to Dr. Auerbach's letter concerning maintenance dosage of methotrexate, I certainly agree that methotrexate should not be maintained when conventional therapy will control the psoriasis. In our article, we pointed out that methotrexate was to be used only in severe cases of psoriasis which were unresponsive to conventional methods of therapy.Certainly, I would agree that methotrexate should be withdrawn as quickly as possible, but clinically this is often impossible. Many patients with severe psoriasis will flare in two to three weeks if their methotrexate is suddenly stopped. We have even seen some cases of rebound with more severe psoriasis as is seen after oral corticosteroid therapy.Our approach has been to maintain the patient on methotrexate 25 mg/week, orally, until their psoriasis is cleared. We then will gradually reduce this dose of methotrexate and attempt to withdraw the drug especially during the summer months
Roenigk HH. METHOTREXATE-Reply. Arch Dermatol. 1969;100(1):122. doi:10.1001/archderm.1969.01610250128040