Hani N, Casper C, Groth W, Krieg T, Hunzelmann N
Department of Dermatology, University of Cologne, Klinik und Poliklinik für Dermatologie und Venerologie der Universität zu Köln, Joseph-Stelzmannstr. 9, 50924 Köln, Germany.
Eur J Dermatol. 2000 Oct-Nov;10(7):548-50.
A 61 year old male patient suffering from psoriasis vulgaris developed a severe skin reaction with toxic myelosuppression three days after administration of 20 mg methotrexate (MTX) p.o. per week and concomitant 100 mg acetylic salicylic acid (ASA) per day. The skin lesions simulated Stevens-Johnson syndrome with ulcerations of the oral mucosa and erythema multiforme-like target lesions. The histology of the epidermis resembled an acute graft-versus-host reaction. The increased toxic effect of MTX on keratinocytes in our patient was most likely caused by a lowered plasma binding capacity and reduced renal excretion of MTX due to concomitant administration of ASA. Thus in the treatment of severe forms of psoriasis with MTX, the combined administration of drugs aggravating MTX toxicity, particularly of ASA, should be carefully considered, due to the increased toxicity and risk of severe skin reactions.
一名61岁寻常型银屑病男性患者，在每周口服20 mg甲氨蝶呤（MTX）并同时每日服用100 mg乙酰水杨酸（ASA）三天后，出现严重皮肤反应并伴有毒性骨髓抑制。皮肤损害类似史蒂文斯-约翰逊综合征，伴有口腔黏膜溃疡和多形红斑样靶形损害。表皮组织学表现类似于急性移植物抗宿主反应。该患者中MTX对角质形成细胞毒性作用增强，很可能是由于同时服用ASA导致MTX血浆结合能力降低和肾脏排泄减少所致。因此，在使用MTX治疗重度银屑病时，鉴于毒性增加和严重皮肤反应风险，应谨慎考虑联合使用加重MTX毒性的药物，尤其是ASA。
