LOW-DOSE METHOTREXATE ADMINISTERED WEEKLY IS AN EFFECTIVE CORTICOSTEROID-SPARING AGENT FOR THE TREATMENT OF THE CUTANEOUS MANIFESTATIONS OFDERMATOMYOSITIS

Background: The cutaneous manifestations of dermatomyositis can be the most prominent finding and are often difficult to treat. Objective Ou r purpose was to determine whether low-dose methotrexate administered weekly in combination with other systemic therapies or as a sole syste mic agent is effective in the treatment of the cutaneous disease in pa tients with dermatomyositis. Methods: We reviewed the records of 13 pa tients who received oral methotrexate in doses ranging from 2.5 to 30 mg weekly. Their skin lesions had not been completely responsive to su nscreens, topical corticosteroids, oral prednisone, oral antimalarial therapy, and, in one patient each, chlorambucil and azathioprine. Resu lts: At the end of the study period, 4 of these 13 patients were free of all cutaneous manifestations of dermatomyositis, and another four h ad almost complete clearing. In the remaining five patients, methotrex ate induced moderate clearing of their cutaneous lesions. In all patie nts, the addition of methotrexate allowed reduction or discontinuation of other therapies such as prednisone. All patients tolerated the met hotrexate with minimal toxicity. Conclusion: Low-dose oral methotrexat e administered weekly is effective in treatment of the cutaneous manif estations of dermatomyositis and frequently enables a reduction or dis continuation of corticosteroid therapy.