Thirteen patients with pemphigus vulgaris were treated over a period of months or years with a combination of steroids and methotrexate. Antiepithelial antibodies were reduced in titer with the administration of these drugs. In ten of 13 patients side effects of methotrexate were quite severe despite low dosages. Methotrexate in adequate amounts would have been discontinued had not the use of leucovorin calcium, the specific antidote for methotrexate, been added as part of therapy. When leucovorin calcium was administered at intervals of one-half to three hours after injection of methotrexate, immunosuppressive action of methotrexate could be maintained in a majority of patients. In our experience flexibility in administration of the use of methotrexate alone or in combination with steroids and leucovorin calcium is recommended in the treatment of pemphigus.
Peck SM, Osserman KE, Samuels AJ, Berger BW, Osserman RS. Studies in Bullous Diseases: Treatment of Pemphigus Vulgaris With Immunosuppressives (Steroids and Methotrexate) and Leucovorin Calcium. Arch Dermatol. 1971;103(2):141–147. doi:10.1001/archderm.1971.04000140027005
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