Fifty patients with psoriasis were evaluated prospectively and retrospectively for possible hepatotoxicity from methotrexate therapy. Liver function studies were not reliable indicators of pathologic changes found on liver biopsy. Diabetes mellitus and obesity increased the incidence of hepatotoxicity from methotrexate. Increased alcohol consumption may not be an additive risk in producing liver damage. A variety of pathologic changes were found on liver biopsies, but none were specific for methotrexate hepatotoxicity. There is no close correlation between the total dose of methotrexate and the degree of liver abnormalities. Continued use of methotrexate for treatment of severe psoriasis will require better selectivity of patients and closer follow-up studies including liver biopsy.
Roenigk HH, Bergfeld WF, Jacques RS, Owens FJ, Hawk WA. Hepatotoxicity of Methotrexate the Treatment of Psoriasis. Arch Dermatol. 1971;103(3):250-261. doi:10.1001/archderm.1971.04000150020003