How can we optimize the use of methotrexate to treat pediatric patients with inflammatory skin diseases?

ABSTRACT

Introduction

Methotrexate (MTX) is a folic acid antagonist used in clinical practice in oncology and rheumatology, as well as in the treatment of inflammatory skin conditions in children. The low-doses of MTX are commonly used in children for the treatment of many inflammatory and autoimmune conditions, including inflammatory skin diseases, due to its anti-inflammatory and immunomodulatory effects.

Areas covered

This review discusses the possibilities for optimizing the use of methotrexate in the treatment of pediatric patients with inflammatory skin diseases. A thorough search through PubMed and Embase databases was performed to identify relevant literature.

Expert opinion

Clinical observations confirm the high efficacy and safety of low-dose MTX in children with inflammatory skin diseases. Unfortunately, to date there are few studies providing guidelines on the optimal dosage of MTX in children with inflammatory skin diseases; routes of administration; principles of monitoring; and the safety of long-term use of this medication in children. There is still a need for specific recommendations on the safest and most effective dosing and monitoring regimen for children treated with methotrexate for inflammatory skin diseases.

KEYWORDS:

• Methotrexate
• skin
• therapy
• inflammation

Article highlights

• Methotrexate is an antifolate and an immunomodulatory agent used in the treatment of pediatric inflammatory skin disorders, such as atopic dermatitis, psoriasis, alopecia areata, and morphea.

• Many patients respond to the treatment with methotrexate; however, optimization of therapy and investigation of potential non-responders is greatly needed.

• Possible methods to improve the outcomes of treatment involves folic acid supplementation, changing the drug in the occurrence of significant adverse events or in the presence of comorbidities that would increase the risk of toxicity, combination with other drugs, and application of pharmacogenetics to identify potential non-responders.

• Recently, many biologic agents have been developed and studied in children with skin conditions. Potential benefits of combination of methotrexate with biologics should be further evaluated.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.