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February 1984

Methotrexate and Etretinate as Concurrent Therapies in the Treatment of Psoriasis

Author Affiliations

Marselisborg Hospital PP Orumsgade II 8000 Aarhus, Denmark

Arch Dermatol. 1984;120(2):155. doi:10.1001/archderm.1984.01650380015002

To the Editor.—  In the September 1982 Archives (118:660-662), Vanderveen et al stated that 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. They based their suggestion on the report of a single case. I report herein a case of severe, life-threatening hepatitis that occurred in a patient when concurrent therapy with methotrexate and etretinate was undertaken.

Report of a Case.—  A 47-year-old woman had had psoriasis since the age of 19 years and had been receiving methotrexate therapy since 1971. She had taken a weekly divided intermittent oral dosage of the drug. In November 1979, a liver biopsy specimen showed only mild fibrosis and slight Kupffer's cell proliferation. In addition to methotrexate therapy, the patient had received 248 psoralens and UV-A (PUVA) treatments from January 1976 to April 1980, taking 20 mg

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