Treatment of prurigo with methotrexate: a multicentre
retrospective study of 39 cases
, S. Ingen-Housz-Oro
Departement of Dermatology, AP-HP H
opital Henri Mondor, Cr
Departement of Dermatology, H
e, CHU de Bordeaux, Bordeaux, France
Departement of Dermatology, H
opital Charles Nicolle, CHU de Rouen, Rouen, France
Departement of Dermatology, Hopital de la Timone, Marseille, France
UMR 911, INSERM CRO2, Center for Research in Biological Oncology and Oncopharmacology, Timone Hospital Public Hospitals of
Marseille, Aix-Marseille Univ, Marseille, France
Departement of Dermatology, Centre hospitalier Lyon-Sud, Lyon, France
Departement of Dermatology, Centre hospitalier de Brest, Brest, France
EA 7379 EpiDermE (Epid
emiologie en Dermatologie et Evaluation des Th
erapeutiques), UPEC, Cr
e Paris-Est Cr
eteil Val de Marne (UPEC), Cr
*Correspondence: S. Ingen-Housz-Oro. E-mail: email@example.com
Background Prurigo is a common primary pruritic condition. Treatment is challenging. Methotrexate (MTX) is effective
for the treatment of pruriginous dermatoses, but its use in prurigo has been little studied.
Objectives To investigate the efﬁcacy and safety of MTX in the treatment of difﬁcult-to-treat prurigo.
Methods Patients from six university dermatology departments treated with MTX between 2006 and 2016 for difﬁcult-
to-treat prurigo (i.e. with failure to conventional therapies) were included in this retrospective multicentre study. Patients
with other pruritic dermatoses were excluded. Clinical efﬁcacy was recorded after 3, 6 and 12 months of treatment: (i)
subjective efﬁcacy, that is, evaluation of the pruritus by the patient and (ii) objective efﬁcacy, that is, assessment of cuta-
neous lesions by the physician: complete or almost complete remission (CR) (healing of lesions), partial remission (PR)
(incomplete improvement of lesions) or failure (no improvement or worsening). The overall response rate (ORR) included
CR and PR.
Results Thirty-nine patients with previous failure of topical steroids, H1-antihistamine drugs or phototherapy were
included. The median weekly dose of MTX was 15 mg (range 5–25 mg). The median follow-up was 16 months (2–108).
The mean time between onset of MTX and objective efﬁcacy was 2.4 Æ 1.2 months and the mean duration of response
was 19 Æ 15 months. The ORR was 91% at 3 months [n = 36, CI 95% (81.2–100.8%), CR 44%], 94% at 6 months
[n = 32, CI 95% (85.7–102.2%), CR 56%] and 89% at 12 months [n = 28, CI 95% (77.4–100.6%), CR 57%]. Seven
patients stopped MTX because of failure, and ﬁve because of the discovery of hepatocarcinoma (n = 1), elevated
transaminases (n = 1), infectious pneumonitis (n = 1) or gastrointestinal symptoms (n = 2).
Conclusion Methotrexate is a therapeutic option in difﬁcult-to-treat prurigo.
Received: 5 September 2017; Accepted: 11 October 2017
Conﬂicts of interest
No conﬂict of interest.
No ﬁnancial disclosure.
Prurigo is a common primary chronic skin disease which highly
affects quality of life.
Clinical subtypes include prurigo
nodularis and excoriated (simplex) prurigo, often associated in
the same patients.
A minor eczematous component may some-
times be associated, but prurigo differs from pruritus associated
with other dermatoses such as bullous pemphigoid, atopic
ezary syndrome and scabies. Therapeutic
These authors contributed equally to this work.
© 2017 European Academy of Dermatology and Venereology
2018, 32, 437–440