Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series
BackgroundTraditional 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...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Allergy |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/falgy.2025.1634055/full |
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| author | Yunhong Zheng Yunhong Zheng Yinzi Dubai Ruizhe Wang Suju Luo |
| author_facet | Yunhong Zheng Yunhong Zheng Yinzi Dubai Ruizhe Wang Suju Luo |
| author_sort | Yunhong Zheng |
| collection | DOAJ |
| description | BackgroundTraditional 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.MethodsWe 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.ResultsAmong 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 h 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.ConclusionsTCM containing MTX may induce skin ulceration in rare cases among patients with psoriasis. |
| format | Article |
| id | doaj-art-375f4855c43849e1807d2ede5833021c |
| institution | Kabale University |
| issn | 2673-6101 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Allergy |
| spelling | doaj-art-375f4855c43849e1807d2ede5833021c2025-08-20T03:47:23ZengFrontiers Media S.A.Frontiers in Allergy2673-61012025-06-01610.3389/falgy.2025.16340551634055Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case seriesYunhong Zheng0Yunhong Zheng1Yinzi Dubai2Ruizhe Wang3Suju Luo4Department of Dermatovenereology, Tianjin Medical University General Hospital/Tianjin Institute of Sexually Transmitted Disease, Tianjin, ChinaDepartment of Dermatology, Ulanqab Central Hospital, Inner Mongolia, Ulanqab, ChinaDepartment of Dermatovenereology, Tianjin Medical University General Hospital/Tianjin Institute of Sexually Transmitted Disease, Tianjin, ChinaDepartment of Dermatology, Gem Flower Xi'an Chang Qing Staff Hospital, Xi’an, ChinaDepartment of Dermatovenereology, Tianjin Medical University General Hospital/Tianjin Institute of Sexually Transmitted Disease, Tianjin, ChinaBackgroundTraditional 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.MethodsWe 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.ResultsAmong 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 h 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.ConclusionsTCM containing MTX may induce skin ulceration in rare cases among patients with psoriasis.https://www.frontiersin.org/articles/10.3389/falgy.2025.1634055/fullpsoriasismethotrexate toxicityskin ulcerationtraditional Chineseimmunosuppressive |
| spellingShingle | Yunhong Zheng Yunhong Zheng Yinzi Dubai Ruizhe Wang Suju Luo Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series Frontiers in Allergy psoriasis methotrexate toxicity skin ulceration traditional Chinese immunosuppressive |
| title | Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series |
| title_full | Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series |
| title_fullStr | Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series |
| title_full_unstemmed | Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series |
| title_short | Painful skin ulcers in psoriasis patients after taking methotrexate-containing traditional Chinese medicine: a retrospective case series |
| title_sort | painful skin ulcers in psoriasis patients after taking methotrexate containing traditional chinese medicine a retrospective case series |
| topic | psoriasis methotrexate toxicity skin ulceration traditional Chinese immunosuppressive |
| url | https://www.frontiersin.org/articles/10.3389/falgy.2025.1634055/full |
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