Methotrexate for Eczema

[EEFG]

Has anyone taken methotrexate for eczema. Would be interested to hear good/ bad experiences. I am meant to be starting this in a couple of weeks and am nervous to say the least.

I was given methotrexate for an ectopic pregnancy but maybe in those situations you get a much higher dose - It was an injection and I had to have it at the hospital on the cancer ward of all places. I found it awful plus you can't try and get pregnant whilst you are taking it or for several months after you stop taking it as it's vey dangerous to a developing pregnancy x

Crazyfools I’m so very sorry for your loss. 💕 x

Aragog do you mind me asking how many mg you are on per week

I haven't read the full thread but I have previously been on immunosuppressants for severe eczema. It wasn't methotrexate but I was on 3 other kinds over the course of 3 ish years. It helped but didn't cure or reduce enough not to need steroid creams and I was still getting severe flares a few times a year which would send me to bed for at least a week, usually more. I was exhausted from severe lack of sleep and my quality of life was affected. Until I found Dr Richard Aron. Look him up and the patients of Dr Aron Facebook page. His treatment changes my life. My skin is extremely well controlled now. I'm off all immunosuppressive medication and due to this I am now a mum. I could never have considered pregnancy wihout my skin being under control and of course not on immunosuppressants. I can't explain how much better I am. My nhs dermatologist has discharged me and my gp is supportive of the treatment.
Good luck whatever you decide OP.

Tablets wise - 15mg (6 tablets, spread over two days) I assume the injection is the same - not got one at hand and it's slipped my memory.

It's bit the only meds I'm on for the arthritis but the psoriasis cleared a few weeks or so after starting it.
Steroids did help previously before that but not a long term option for me.

Triangled

So you are saying a child with no visible skin problems needs steroid treatment?

No, I’m saying a child with ongoing eczema should still be using steroids. They should have a plan for their “preventer” ie barrier protection and moisturiser, and avoiding triggers, and plan for their “reliever” ie steroids for flares.

Steroids are not "very safe" at all.

Did you even read the article I linked, or do you just not want to hear the evidence-based opinion of all of the preeminent paediatric dermatologists in Australasia?

Had we weaned her off steroids earlier we would have seen that her eczema was disappearing through diet. The steroids were masking that effect.

This just isn’t true. If your daughter’s skin took months to improve after cutting out food, it’s likely the food removal played little role in the skin improvement. This is typical confirmation bias from parents with eczema: you did something, things got better, so it’s because of what you did.

People who say steroid use is perfectly safe clearly haven't had to use them...or haven't used them long enough to see the damage they do.

I have used Elocon ointment for 25 years to manage my eczema. It has waxed and waned in severity over time. Incidentally I am amazed at the frequency of cream being mentioned over ointments. Ointments are far superior and should always be first choice.

Just came across this article. You might find it useful

That article is a piece of garbage. If a so-called doctor can’t get the name of allergy antibodies correct - it’s IgE for allergy, not IgG - then clearly there is no credibility.

OP

Have you tried Elidel (pimecrolimus) for around the eyes? Commonly used as a steroid sparing agent in those areas. Also very good for perioral eczema. Need to avoid sunlight if using.

NotBadConsidering - yes - unfortunately I couldn’t tolerate Elidel at all. Terrible reaction. Felt like my face was being attacked by a blow torch and I am not exaggerating even slightly! Yes I find elocon ointment one of the best but is too strong for the face for length of time my flares last. It just doesn’t seem to control it any more. 😢

It really does sound like you’ve reached the point of other immunosuppressive treatments. I can’t recommend one over the other because they all have pros and cons, but if it was me, I would approach it as a trial, with consideration of stopping if it doesn’t agree or help, the same as treatments you’ve tried before. Really good up to date summary of trials, side effects etc here:

www.ncbi.nlm.nih.gov/pmc/articles/PMC6357995/

Incidentally I am amazed at the frequency of cream being mentioned over ointments. Ointments are far superior and should always be first choice.

Ointments have heavier liquid paraffin content which my daughter was reacting to. The least bad irritant was Dermol cream. Dermol ointment made her scratch like crazy.

The article I linked to mentioned several potential root causes of autoimmune disorders to consider (e.g. yeast infections). That's the only reason I linked to it.

This just isn’t true. If your daughter’s skin took months to improve after cutting out food, it’s likely the food removal played little role in the skin improvement. This is typical confirmation bias from parents with eczema: you did something, things got better, so it’s because of what you did.

OK. Whatever you say must be true because you were clearly there and trialled the various ointments on my daughter's skin? I'm telling you what her consultant (who was there) observed. She was reacting to all her prescribed ointments. When we stopped the ointments her skin dramatically improved. When we reintroduced the ointments or her skin flared up massively. Had we not stopped the oinments we would not have seen any skin improvements. Her consultant wrote in one letter to our GP that "her eczema has now resolved" because on a follow up visit she had clear skin...after stopping her all skin potions. The diet hadn't changed in the background. She was dairy-free from 6 months old but not eczema free until over a year at the time we weaned her off steroids. The steroid creams/moisturising ointments were perpetuating the red raw itchy skin. The only other time she was free from eczema was when she had chicken pox and therefore off steroid cream. We didn"t twig at the time and even her consultant said he was amazed that the week before the pox her eczema was horrendous but when the spots came out all the skin around them dramatically cleared. As soon as pox disappeared, which took a while as it was a terrible dose for which she was hospitalised (ironically thanks to steroid use), they had her back on steroid cream and her eczema dramatically worsened. Diet was a constant the whole time as she was breastfed and I was dairy/egg free.

Anyone who thinks steroid creams are safe needs to meet my son.
12 years old, has extremely thin skin in places, and is now steroid dependant, as the steroid creams have contributed towards adrenal insufficiency. It's not solely the creams, he's on high doses of steroid inhalers too, and regular courses of oral steroids for his skin and his asthma, but, still, the steroid creams (and ointments) have contributed.
He now has to take oral steroids 3 times a day, and carries injectable steroids in case of accidents or illness. His name has a flag with the ambulance service so he'll always be top priority for an ambulance, and he suffers in more ways than you could even imagine.
Steroid creams are not safe, long term.

Whitelisbon
From the article I linked above:

“HPA axis suppression can occur following use of any exogenous steroid. Physiological adrenal suppression has been defined as a ‘cortisol level below the normal range but with the capacity for prompt recovery’ while pathological adrenal suppression is described as ‘a state of adrenal insufficiency, adrenal crisis or persistent laboratory evidence of adrenal suppression without prompt recovery’.35 Following exposure to exogenous corticosteroid, the body adjusts the HPA axis through the physiolo- gical suppression of endogenous cortisol. Following weeks to months of persistent exogenous corticosteroid exposure, the adrenal glands may become atrophic and are temporarily unable to produce adequate glucocorticoids to meet the body’s requirements. In this situation, the adrenal suppression becomes pathological and an adrenal crisis may occur.
Following TCS use, temporary physio- logical adrenal suppression may be apparent within 2–4 weeks but is quickly reversible and the patient recovers fully.35–38 We are unaware of any reports of patho- logical adrenal suppression during the use of TCS that is discontinued on resolution of the active eczema.

In a review of 16 TCS trials that recorded HPA suppression, only one reported pathological adrenal suppression: five adult psoriasis patients who used more than 100 g clobetasol propionate a week for between 10 weeks to 18 months developed features of Cushing’s syndrome. On withdrawal they suffered symptoms of adrenocortical insufficiency; and in addition they developed pustular psoriasis.35

There are 25 case reports in the literature of HPA axis suppression. These children mostly used super-potent topical steroids (clobetasol proprionate) for 1-17 months for diaper eczema.39-47

There have been two reports of death due to sepsis in association with marked overuse of TCS in very young infants.48,49
It is clear that physiological HPA axis suppression can occur for the duration of treatment with potent TCS. When used for routine eczema management in children, pathological HPA suppression has not been reported.

Summary

Physiological HPA axis suppression can occur with widespread and prolonged, or occlusive use, of potent/superpotent TCS. Clinically significant or pathological adre- nal suppression is very rare in the treatment of paediatric eczema with topical agents.”

What has happened to your son is a recognised problem, but incredibly rare, so much so that his skin specialist should write him up as a case. HPA from asthma treatment is much more common however, and highly likely to be the biggest contributor. But it doesn’t change the fact that steroids are safe and effective treatment for eczema for the majority of people.

These single anecdotes of rare exemptions to the usual - a child reacting to ointments, a child with HPA suppression - do not mean that ointments aren’t better and steroids are bad. It means that people with exceptional experiences of eczema in their children are posting about it on MN. I have no problem with that, but these are rare, exceptional experiences which should be remain in that context and do not outweigh evidence based consensus of overall treatment.