Methotrexate cream

Two patients taking iow-dose methotrexate had a toxic skin reaction when they started to use a cream containing fluorouracil. The activity of systemic treatment with methotrexate and fluorouracii are said to be dependent on the order in which the two drugs are given, but this does not appear to be important in the commoniy used CMF regimen. 

Treatment has been difficult as the modalities that are useful in acne vulgaris are often ineffective in chloracne. Topical application of retinoic acid (0.005-0.3% concentration) or of tretinoin (Retin-A) gel or cream is of some benefit in controlling comedones, but other topical agents are of little use (Caputo et al. 1988). A combination of tetracycline and short courses of orally administered prednisone helped with severe inflammatory cases. A trial regimen of methotrexate, 25 mg every 10 days for several months was unsuccessful (Taylor et al. 1977). 

Abbreviations. increase decrease oo, restrict dietary calcium F, high fluid intake CED, corticosteroid eye drops CP, cycloplegics C, corticosteroids— usually 20 to 40 mg prednisone equivalent/day M, methotrexate A, azathioprine I, infliximab CC, corticosteroid creams Cl, corticosteroid injections H, hydroxychloroquine CQ, chloroquine NSAID, non-steroidal anti-inflammatory drugs CYC, cyclophosjliamide. Source. From Ref 246. 

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