Combined methotrexate-ultraviolet B therapy in the treatment of psoriasis

Twenty-six patients with extensive psoriasis were treated with a 3-week course of methotrexate followed by a combination of ultraviolet B (UVB) therapy and methotrexate. A plaque of psoriasis was shielded during UV therapy to serve as a control. When lesions cleared to 2 . The mean total dose of methotrexate was 112 mg (range, 75 mg-165 mg). At the time of clearing, the shielded area had a decrease in scaling and thickness in twenty-two patients but was free of psoriasis in only four patients. In a preliminary study we were unable to reproduce a methotrexate recall of UV-induced erythema. The combination therapy of methotrexate and UVB allows for clearing of psoriasis at relatively low doses of UVB and methotrexate, and thus may reduce the long-term cumulative toxicity of both agents.