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April 1991

Systemic Drug Therapy for Psoriasis: The Most Critical Issues

Author Affiliations

Department of Dermatology Indiana University Medical Center 1100 W Michigan St Regenstrief Health Center 524 Indianapolis, IN 46202

Arch Dermatol. 1991;127(4):565-568. doi:10.1001/archderm.1991.04510010133018

Guzzo and colleagues1 present, in this issue of Archives, the results of a phase I and II study of piritrexim, a nonclassical folate antagonist, for the reatment of severe psoriasis. This open study demonstrated a dose-dependent improvement in psoriasis patients receiving at least 100 mg/d for 5 consecutive days every 2 weeks. Reversible hepatotoxicity or leukopenia were noted in several patients. The hepatotoxicity was surprising in view of the rarity of this adverse effect in the oncology literature.

See also p 511.

Using the piritrexim article as a springboard for discussion, this editorial briefly addresses issues confronting dermatologists who prescribe systemic chemotherapy for patients with severe psoriasis. The risks and benefits of methotrexate, cyclosporine, and hydroxyurea in the treatment of psoriasis are discussed. Although retinoids and psoralen plus UV-A (PUVA) are beyond the scope of this discussion, the principles that follow can be applied to these therapies as well.

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