Methotrexate, the oldest systemic therapy for psoriasis, remains one of the most effective treatments for psoriasis and psoriatic arthritis. It has a number of short term side effects including bone marrow toxicity, nausea, aphthous stomatitis, and development of megaloblastic anaemia. Even when properly prescribed, bone marrow toxicity of methotrexate is responsible for several deaths each year.25 Caution must be used in administering other medications to patients on methotrexate because certain drugs result in higher methotrexate levels. Specifically, co-trimoxazole (trimethoprim/sulfamethoxazole) results in increased methotrexate toxicity by several mechanisms.26 Decreases in renal function lower methotrexate clearance thereby increasing toxicity, and thus methotrexate needs to be used with increased caution in the elderly.27 Certain non-steroidal anti-inflammatory drugs also interfere with methotrexate secretion.26 Nausea and megaloblastic anaemia of methotrexate can be avoided by concomitant prescription of folic acid (1–5 mg daily) although this may interfere with the efficacy of methotrexate.28
Rice Research: Open Access Open Access Journal 2017 Awards 16. Mehlis S. Guttate Psoriasis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/guttate-psoriasis. Last updated November 22, 2016. Accessed September 1, 2017.
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View All On average, the overall quality of the evidence was moderate for the three most important comparisons that included corticosteroids (e.g. betamethasone dipropionate), vitamin D (e.g. calcipotriol) and their combination product. We looked for a reduction in the severity of the psoriasis, improvement in quality of life and harmful side effects of the treatments. Most findings were based on short-term therapies with a duration of less than six months.
Psoriasis is known to have a negative impact on the quality of life of both the affected person and the individual's family members. Depending on the severity and location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care and sleep. Participation in sporting activities, certain occupations, and caring for family members can become difficult activities for those with plaques located on their hands and feet. Plaques on the scalp can be particularly embarrassing, as flaky plaque in the hair can be mistaken for dandruff.
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