Two men, 37 and 52 years of age, had postnecrotic cirrhosis after the treatment of psoriasis with methotrexate for five years. Five other patients with serious hepatotoxicity documented by liver biopsies are also discussed. Clinical signs of serious hepatic damage may be the first indication of cirrhosis; liver function tests are not dependable. Clinical improvement usually occurs after the drug is discontinued. Methotrexate should be recognized as a hepatotoxin, even when given in low dosage.