Methotrexate in the Treatment of Chronic Itch in the Geriatric Population

TAKE-HOME MESSAGE This case series included 3 patients (74 to 81 years of age) with severe pruritus unresponsive to other topical or oral medications. Cutaneous findings included urticarial dermatitis or prurigo nodularis, whereas biopsies showed nonspecific spongiotic dermatitis. Itch ratings on a numerical rating scale ranged from 8 to 10. After 6 to 18 weeks from initiating methotrexate 12.5 to 15 mg weekly, itch ratings decreased significantly. While 2 patients reported having no itch, 1 patient reported an itch rating of 3. Full blood counts and comprehensive metabolic panels were obtained at baseline, then every month for the first 6 months, and then every 2 months after the patient was on a stable dose. Side effects included drowsiness in 1 patient. Low-dose methotrexate may be a cost-effective and effectual treatment for reducing pruritus in the geriatric population with complex comorbidities. After a notable itch reduction for a few months at 12.5 to 15 mg weekly, a slow tapering to 2.5 to 5 mg weekly is recommended. Investigation in a larger population is warranted. – InYoung Kim, MD, PhD

Itch is a very common dermatologic symptom in the geriatric population, ranging from 7% to 37.5%, and severely impacting quality of life (1). Risk factors for developing chronic pruritus in the geriatric population are multifactorial including immunosenesence, dry skin and neuropathies (2). Treatment of pruritus in the elderly imposes a challenge due to multiple comorbidities and possible drug interaction (3). Methotrexate is an immunosuppressant that has been used since the 1960s to treat many dermatoses such as psoriasis, atopic dermatitis, bullous disorders, and cutaneous lymphoproliferative disorders (4). Its proposed anti-inflammatory and immunomodulating mechanisms of action are related to the adenosine pathways and nucleic acid synthesis inhibition in activated T cells and keratinocytes, respectively (4). However, its exact anti-pruritic mechanism of action is unknown. Here, we present the use of low-dose methotrexate in a geriatric population with multifactorial and severe pruritus that was unresponsive to numerous other oral and topical treatments.

Acta Dermato-Venereologica Methotrexate in the Treatment of Chronic Itch in the Geriatric Population Acta Derm Venereol 2019 Oct 21;[EPub Ahead of Print], C Kursewicz, R Valdes-Rodriguez, G Yosipovitch

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Dermatología en Costa Rica