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Low dose methotrexate therapy is effective in late-onset atopic dermatitis and idiopathic eczema.

BACKGROUND
Atopic dermatitis or atopic eczema is an itchy inflammatory skin condition with a predilection of the skin flexures. Most cases start in children although some have been reported in adults. Patients with moderate to severe disease refractory to topical corticosteroid or calcineurin inhibitors may require second-line treatment such as phototherapy or systemic immunosuppressants. Methotrexate therapy has been suggested as a useful immunosuppressant in adult atopic dermatitis.


OBJECTIVES
To further determine the efficacy of low dose methotrexate therapy in adults with new-onset atopic dermatitis or with idiopathic eczema.


METHODS
All adult patients with new-onset atopic dermatitis or idiopathic eczema treated by methotrexate in our clinics from 2004 to 2006 were included in the study. All had failed prolonged therapy with oral antihistamines and local corticosteroid creams. Methotrexate, 10-20 mg, was given orally once a week along with folic acid supplements 5 days a week. Additional therapies included predominantly emollients. During the entire treatment period the investigators made global assessments of the clinical response.


RESULTS
Nine patients diagnosed with late-onset atopic dermatitis (n = 6) or idiopathic eczema (n = 3) were treated with methotrexate. All patients responded to the drug. The initial response was noted after 3-7 weeks. Six patients achieved complete remission after 3 months of methotrexate therapy and three patients had significant improvement. One patient's condition worsened after achieving a complete response while on methotrexate and the drug was withdrawn completely. No serious adverse events were noted during treatment.


CONCLUSIONS
Low dose methotrexate is an effective therapeutic alternative for late-onset atopic dermatitis or idiopathic eczema in patients unresponsive to local and other systemic therapies.