ORIGINAL RESEARCH article
Front. Allergy
Sec. Skin Allergy
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1634055
This article is part of the Research TopicBiologics in Allergic Skin Diseases: Advances in Atopic Dermatitis, Urticaria, and BeyondView all articles
Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series
Provisionally accepted
- 1Department of Dermatovenereology, Tianjin Medical University General Hospital, Tianjin, China
- 2Ulanqab Central Hospital, Inner Mongolia, China
- 3Gem Flower Xi'an Chang qing Staff Hospital, Xi’an, China
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Background: Traditional Chinese Medicine (TCM) has demonstrated certain efficacy in the treatment of psoriasis, a chronic papulosquamous skin disease. However, in rare instances, the use of TCM may exacerbate cutaneous lesions. This study aims to explore whether the methotrexate (MTX) component in TCM may increase the risk of cutaneous ulceration in patients with psoriasis. MTX is also an immunosuppressive agent widely used in the treatment of various dermatologic conditions.: We retrospectively analyzed the medical records of five patients who developed painful skin ulcers at primary psoriatic sites after taking TCM. Evaluated indicators included hemocytopenia, liver function, serum MTX concentration, and ABCB1 gene polymorphisms. Histopathological examination was also performed on ulcerative tissue samples. Results: Among the five patients, two developed hemocytopenia and two had abnormal liver function. Serum MTX concentrations in two patients ranged from 0.03 to 0.11 μmol/L (<0.1 μmol/L at 72 hours after MTX administration). The ABCB1 genotypes AA and AG were detected in two different patients. Histopathological findings revealed dyskeratosis of keratinocytes, dermal vasodilation, and inflammatory cell infiltration. Rescue treatment with oral folic acid was administered to three patients, leading to complete healing of all lesions within two weeks. The remaining two patients showed gradual improvement in skin ulcers after discontinuing TCM. Conclusions: TCM containing MTX may induce skin ulceration in rare cases among patients with psoriasis.
Keywords: Psoriasis, Methotrexate toxicity, Skin ulceration, Traditional Chinese, immunosuppressive
Received: 23 May 2025; Accepted: 09 Jun 2025.
Copyright: © 2025 Zheng, Dubai, Wang and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Suju Luo, Department of Dermatovenereology, Tianjin Medical University General Hospital, Tianjin, China
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