Methotrexate has been a valuable drug in the management of severe generalized psoriasis for over 35 years as pointed out in the article by Gilbert et al1 in this issue of the Archives. Gubner2 described the benefit of aminopterin (precursor of methotrexate) in the clearing of psoriatic skin lesions See also p 889. in 1951 while using methotrexate to treat rheumatoid arthritis. This cancer chemotherapeutic drug became standard therapy for severe psoriasis from 1955 to 1972 despite its lack of approval by the Food and Drug Administration (FDA). In 1965, Roenigk et al3 reported a new weekly dosage schedule of methotrexate for use in psoriasis. We found "a few minimal changes in hepatic function studies in eight of 45 psoriatics" receiving methotrexate. Since other authors were beginning to report methotrexate-induced hepatic injury, we cautioned that future followup studies were needed to determine the long-term effect of methotrexate
ROENIGK HH. Methotrexate and Liver Biopsies: Is it Really Necessary? Arch Intern Med. 1990;150(4):733–734. doi:10.1001/archinte.1990.00390160011003
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