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July 1969


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909 Fifth Ave New York 10021

Arch Dermatol. 1969;100(1):121-122. doi:10.1001/archderm.1969.01610250127039

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To the Editor.—  Regarding the article by Roenigk et al on "Methotrexate for Psoriasis in Weekly Oral Doses" (Arch Derm99:86 [Jan] 1969), I would like to make the following comments.While we may have several points of agreement or disagreement in the article, I believe the most objectionable concept is that of a maintenance dose. Once the psoriasis has cleared the patient should be kept off methotrexate until the psoriasis begins to return with such severity as to once again justify the use of methotrexate. Maintenance dosage schedules of methotrexate will result in the patient ingesting larger total amounts of methotrexate with the unknown hazards of unknown forms of chronic toxicity. Should there be no chronic toxicity nothing is lost.However, in reviewing the charts of some recent cases of liver damage, which has been blamed on methotrexate, the underlying theme in all these patients was inadequate rest

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