Methotrexate-induced epidermal necrosis: A case series of 24 patients

Journal of the American Academy of Dermatology
Ting-Jui ChenShuen-Iu Hung

Abstract

Methotrexate-induced epidermal necrosis (MEN) is a rare but life-threatening cutaneous reaction that mimics Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To investigate the clinicopathology, risk factors, and prognostic factors of MEN. We enrolled 24 patients with MEN and 150 controls and analyzed the demographics, pathology, and plasma concentrations of methotrexate (MTX). Patients with MEN showed extensive skin necrosis (mean, 33.2% total body surface area) but no target lesions. The histopathology displayed keratinocyte dystrophy. Early signs of MEN included painful skin erosions, oral ulcers, and leukopenia/thrombocytopenia. Although 79.2% patients received leucovorin treatment, there was 16.7% mortality. Risk factors for MEN included older age (>60 years), chronic kidney disease, and high initial dosage of MTX without folic acid supplementation. Renal insufficiency delayed MTX clearance. Severe renal disease and leukopenia predicted poor prognosis in MEN, but none of the SCORe of Toxic Epidermal Necrosis criteria were associated with mortality of MEN. The study was limited by the small sample size. MEN exhibited distinct clinicopathologic features from SJS/TEN. Recognition of the early signs and prog...Continue Reading

References

Dec 25, 2016·The Journal of Investigative Dermatology·Shih-Chi SuWen-Hung Chung

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Citations

Dec 1, 2017·Clinical Reviews in Allergy & Immunology·Marianne LerchThomas Harr
Jun 7, 2019·Journal of Wound Care·Kirsi IsoherranenMar Llamas Velasco
Sep 10, 2020·JAAD Case Reports·Malika A LadhaVimal H Prajapati
Apr 9, 2021·Pediatric Dermatology·Manisha RaviEsteban Fernandez Faith
Jun 1, 2021·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Rajiv Ranjan KumarRajat Chhabra

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