Connect with others who understand.

sign up log in
About MyPsoriasisTeam

Methotrexate for Psoriasis

Posted on April 20, 2021
Medically reviewed by
Alexa B. Kimball, M.D., M.P.H.
Article written by
Julie Scott, ANP-BC, AOCNP

Methotrexate is a medication that has been used to treat psoriasis and psoriatic arthritis since 1972. Given in either oral form or by injection, it is used to suppress the immune system and slow cell turnover, both of which are involved in the development of psoriasis.

Many members of MyPsoriasisTeam have been treated with methotrexate. One member stated they were on “methotrexate for years” until it wasn’t as effective. While on methotrexate, “the psoriasis calmed down, and my body didn’t hurt.”

To better understand the use of methotrexate in psoriasis treatment, MyPsoriasisTeam spoke with Dr. Alexa Kimball. Dr. Kimball is a professor of dermatology at Harvard University, and is also CEO and president of Harvard Medical Faculty Physicians, Beth Israel Medical Center.

What Is Methotrexate, and How Does It Work?

A medication in the class of antimetabolites, methotrexate works by blocking a cell’s ability to continue to replicate and make copies of itself. In psoriasis, an overactive immune system allows skin cells to have an abnormally fast growth cycle, which results in the symptoms of painful scales and plaques on the skin. Methotrexate suppresses inflammation and decreases the overproduction of skin cells.

Methotrexate is also used to treat rheumatoid arthritis and some cancers, although in those cases, it is typically given in much higher doses than it would be when treating psoriasis.

Methotrexate can be given orally in pill or liquid form, by subcutaneous injection under the skin, or through intravenous infusion. For psoriasis treatment, methotrexate is most often prescribed by dermatologists in pill form or as an injection, usually given once a week. When taking methotrexate, folic acid levels in the body may be depleted, and often, a folic acid supplement is recommended.

Who Should Take Methotrexate?

Initial therapy for psoriasis often involves a topical cream or ointment, such as a steroid cream. When topical therapy is no longer effective or does not provide adequate improvement in symptoms, systemic therapy is used. Methotrexate is a systemic therapy that can be used for moderate to severe psoriasis. This medication has not been used as frequently since biologics became available, as clinical trials have shown methotrexate to have a better treatment response over placebo, but reduced effectiveness when compared to biologic therapy.

“I definitely do use methotrexate,” Dr. Kimball said. “[But] I certainly use it less for psoriasis than I used to.” Methotrexate has a success rate of 25 percent to 30 percent as compared to biologics, which feature a success rate of 80 percent to 85 percent, she explained.

Dr. Kimball finds that the group in which she uses methotrexate most often includes people on the borderline of having too much disease for topical treatments, but not so much disease as to require biologics. “We also sometimes use it in combination with biologics because of its effectiveness,” she noted.

Benefits of Methotrexate

One of the benefits of using methotrexate to treat psoriasis is that methotrexate is inexpensive, especially compared to biologic therapy. In a 2010 study, estimated costs for a year of methotrexate therapy were around $1,200 as compared to a year of therapy with alefacept, a biologic medication no longer in use, which cost over $27,000. Dr. Kimball stated that in her experience, “sometimes insurers will ask you to try [methotrexate] first” before authorizing use of an expensive biologic medication.

Some MyPsoriasisTeam members have had to try methotrexate before their insurance companies would consider authorizing a biologic. One member commented, “I am just checking a box for the insurance company” while hoping for relief of symptoms.

Convenient dosing is also a benefit, as methotrexate generally only needs to be taken once weekly, and typically in pill form instead of injection or intravenous infusion. Dosing in pill form allows for the medication to be taken at home without any discomfort, and does not require you to travel to an infusion center. If needed to be given by injection, this is typically done by self-injection at home.

After just a few weeks of therapy, many people taking methotrexate noted an improvement in psoriasis symptoms, with maximum improvement typically observed after about three months of therapy. One MyPsoriasisTeam member started to notice an improvement in symptoms “three weeks after starting” and is “hoping for more.”

Drawbacks of Methotrexate

One drawback to using methotrexate is that it is not as effective in treating psoriasis as biologic therapyis, Dr. Kimball explained.

Methotrexate, when used over time, may cause accumulating toxicity, particularly liver disease. Although uncommon, taking methotrexate can increase the risk of developing some cancers, such as lymphoma, melanoma, and lung cancer.

Another drawback is that taking methotrexate typically also requires supplementation with folic acid. Often, people with psoriasis may take other medications as well, and sometimes the addition of more pills can be burdensome.

There is also a group of people in which methotrexate should not be used. This group includes:

  • People with a history of liver disease, such as cirrhosis
  • Those with low counts of white blood cells, red blood cells (anemia), or platelets prior to starting therapy
  • People who are pregnant or nursing

Side Effects of Methotrexate

Low-dose methotrexate given for psoriasis has the potential for side effects, but is generally well-tolerated. The most common side effects include:

  • Fatigue
  • Nausea and vomiting
  • Headaches
  • Bone marrow suppression resulting in low white blood cells, anemia, or low platelets
  • Mild hair loss

Some side effects, such as kidney and liver dysfunction, have been found with long-term use of methotrexate. These risks can be higher in those with other underlying medical conditions, such as obesity or diabetes, or if taking other medications that affect kidney and liver function. Frequent alcohol use while taking methotrexate can also make liver damage more likely. Routine blood tests of kidney and liver function are typically performed to assess for these potential side effects.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 91,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.

Are you living with psoriasis and have been treated with methotrexate? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References

  1. The Role of Methotrexate in Psoriatic Therapy in the Age of Biologic and Biosimilar Medication: Therapeutic Benefits Versus Toxicology Emergencies — An Interdisciplinary Approach to Psoriasis
  2. How Chemotherapy Drugs Work — American Cancer Society
  3. Psoriasis: Diagnosis & Treatment — Mayo Clinic
  4. Methotrexate — MedlinePlus
  5. Joint American Academy of Dermatology-National Psoriasis Foundation Guidelines of Care for the Management of Psoriasis With Systemic Nonbiologic Therapies — Journal of the American Academy of Dermatology
  6. Recent Trends in Systemic Psoriasis Treatment Costs — JAMA Dermatology
  7. A Family Physician’s Guide to Monitoring Methotrexate — American Family Physician
  8. Systemic Methotrexate Therapy for Psoriasis: Past, Present, and Future — Clinical and Experimental Dermatology
Alexa B. Kimball, M.D., M.P.H. is CEO and president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. Learn more about her here.
Julie Scott, ANP-BC, AOCNP is an adult nurse practitioner with advanced practice oncology certification, based in St. Louis, Missouri. Learn more about her here.

A MyPsoriasisTeam Member said:

Glad it is working for you.

posted 6 days ago

hug

Recent articles

Psoriasis is a chronic immune-mediated skin disease with no cure yet, but it’s possible to...

Psoriasis Remission: What Can You Expect?

Psoriasis is a chronic immune-mediated skin disease with no cure yet, but it’s possible to...
Psoriatic arthritis (PsA) is a complex autoimmune disease that occurs in up to one‐third of...

Natural Remedies for Psoriatic Arthritis

Psoriatic arthritis (PsA) is a complex autoimmune disease that occurs in up to one‐third of...
There are many natural treatments for psoriasis and psoriatic arthritis. Some may soothe...

Natural Remedies for Psoriasis: Are They Effective?

There are many natural treatments for psoriasis and psoriatic arthritis. Some may soothe...
Dead Sea salt can be an effective over-the-counter (OTC) remedy for psoriasis. Dead Sea salt is...

Does Dead Sea Salt Help Psoriasis?

Dead Sea salt can be an effective over-the-counter (OTC) remedy for psoriasis. Dead Sea salt is...
Reduced range of motion is one of the most common symptoms of psoriatic arthritis (PsA). PsA is...

Preserving Your Range of Motion With Psoriatic Arthritis

Reduced range of motion is one of the most common symptoms of psoriatic arthritis (PsA). PsA is...
Injections are a common treatment option for people living with psoriatic arthritis (PsA) or...

Injections for Psoriasis Treatment

Injections are a common treatment option for people living with psoriatic arthritis (PsA) or...
Because the physical impact of psoriasis and psoriatic arthritis can be all-consuming, you may be...

How Psoriasis Can Affect Your Mental Health

Because the physical impact of psoriasis and psoriatic arthritis can be all-consuming, you may be...
When you’re dealing with joint stiffness, pain, and other symptoms of a chronic condition like...

Meditation Techniques To Ease Psoriatic Arthritis Symptoms: Q&A With Dr. Blazer

When you’re dealing with joint stiffness, pain, and other symptoms of a chronic condition like...
Download the FULL recipe from this video here.Psoriatic arthritis (PsA) causes inflammation, and...

Can Diet Help Ease Your Psoriatic Arthritis Symptoms?

Download the FULL recipe from this video here.Psoriatic arthritis (PsA) causes inflammation, and...
The month of May is very personal for us at MyPsoriasisTeam, because we honor Arthritis...

Living With Psoriatic Arthritis: A Q&A With MyPsoriasisTeam Members

The month of May is very personal for us at MyPsoriasisTeam, because we honor Arthritis...