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Methotrexate (MTX) has been used in dermatology for several decades. It is mainly indicated for the treatment of psoriasis, some autoimmune diseases and a few chronic inflammatory disorders. The use of this old drug (from 1962 until nowadays) remains empirical, with only few correctly documented studies corresponding to current scientific criteria, despite large utilization due to favourable benefit to risk ratio and low cost. In oncology, the activity of methotrexate has been demonstrated and it is used at very different dosages.
In dermatology, the prescription of MTX was feared for a long time despite its widespread, consensual but elitist use due the lack of training of dermatologists, its particular mode of prescription and the late regularization of its use by the delivery of a French Medical Authorization (MA) (1992, revised in 2011). The development of therapies referred to as “biologic treatments” in the therapeutic armamentarium changed perspectives: MTX has imposed itself as the treatment of reference for severe psoriasis. The efficacy of the new treatments are now compared to that of MTX in clinical trials and the treatments may currently only be prescribed in patients who fail to respond to, or who are intolerant to, or who have a contra-indication to, MTX (French MA).
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