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September 1982

Methotrexate and Etretinate as Concurrent Therapies in Severe Psoriasis

Author Affiliations

From the Department of Dermatology, University of Michigan Medical School (Drs Vanderveen, Ellis, Campbell, Case, and Voorhees), and the Dermatology Service, Veterans Administration Medical Center (Dr Ellis), Ann Arbor.

Arch Dermatol. 1982;118(9):660-662. doi:10.1001/archderm.1982.01650210040015

• A patient with pustular psoriasis, which was inadequately controlled by high-dose methotrexate and potent topical corticosteroid therapy, was treated with oral methotrexate and the aromatic retinoid etretinate. The patient's psoriasis improved with sustained maximal etretinate therapy and continued highdose methotrexate therapy. Subsequently, the methotrexate dose was tapered and use of this drug was discontinued. Previously unattainable success in controlling the psoriasis was achieved with continued etretinate treatment. There were no recognizable adverse effects from concurrent therapy. As the methotrexate dose was tapered, the patient noted increased psoriatic arthritic pain, unrelieved at maximal etretinate levels, but improved with indomethacin treatment. Combination therapy with methotrexate and etretinate may be useful in the treatment of severe psoriasis by providing a controlled transition from methotrexate to etretinate therapy alone.

(Arch Dermatol 1982;118:660-662)

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