Systemic Methotrexate Treatment in 42 Children with Severe Plaque Psoriasis: A Retrospective Study in China

Dermatology. 2022;238(5):919-927. doi: 10.1159/000521262. Epub 2022 Feb 17.


Background: The scientific evidence of methotrexate (MTX) in children with severe plaque psoriasis is scarce.

Objectives: To retrospectively evaluate the efficacy and safety of oral MTX in children with severe plaque psoriasis in a single center in China.

Methods: We enrolled 42 children with severe plaque psoriasis who were administrated MTX. Efficacy was evaluated by the psoriasis area and severity index (PASI) score, physician global assessment (PGA) score, and body surface area (BSA) score. The Children's Dermatology Life Quality Index (CDLQI) score and safety data were recorded.

Results: Among 42 children (22 males, 20 females), the mean age was 11.2 years old. The initial weight-based dosage of oral MTX ranged from 0.1 to 0.3 mg/kg weekly. Overall, 80.6 and 47.2% of patients achieved PASI75 (at least 75% improvement from baseline in PASI score) and PASI90 (at least 90% improvement from baseline in PASI score) at week 12, respectively. 72.2% of patients achieved PGA 0/1 at week 12. BSA and PGA scores significantly decreased from baseline from week 4, accompanied by CDLQI score improvement from week 8. The steady effect of MTX could be reached at week 16. Elevated liver enzymes (28.6%) and infections (28.6%) were the most common side effects. Relapse was recorded in 9 (30.0%) of 30 patients, and the mean posttherapy disease-free interval was 7.2 months.

Conclusions: MTX is an effective and safe option for children with severe plaque psoriasis with adequate monitoring.

Keywords: Immunotherapy; Pediatric dermatology; Psoriasis; Quality of life.

MeSH terms

  • Body Surface Area
  • Child
  • Female
  • Humans
  • Male
  • Methotrexate* / adverse effects
  • Methotrexate* / therapeutic use
  • Psoriasis* / drug therapy
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome


  • Methotrexate