Cutaneous toxicity of oral low-dose methotrexate.

Chemotherapy-induced acral erythema has been a known side effect of intravenous dosing but has not been reported with oral therapy. Herein we describe two patients receiving treatment with low-dose oral methotrexate who presented with acral erythema. Clinicians and rheumatologists should be aware of this potentially serious side effect of oral chemotherapy in various patient populations. This complication related to methotrexate, though rare, should be anticipated in patients on multiple medications who develop mucocutaneous toxicities.