Department of Dermatology, Health Sciences University, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
Dermatol Online J. 2022 Jan 15;28(1). doi: 10.5070/D328157067.
Vitiligo is an acquired skin depigmentation disorder related to the destruction of melanocytes. There are a limited number of case reports and studies in current literature that show methotrexate (MTX) is effective in the treatment. A 44-year-old man presented to our clinic with a one-year history of psoriasis. On dermatological examination, there were erythematous, scaly papules and plaques on knees, elbows, gluteal area, and scalp compatible with psoriasis. In addition there was total depigmentation over the body. He had a 30-year history of vitiligo, beginning localized but progressed gradually and covered the entire body surface. Subcutaneous methotrexate 10mg weekly was started for psoriasis. On the 6th week of methotrexate treatment, he presented to our clinic with newly developed brown macules on his face. The result of the punch biopsy taken from a macule was reported as normal skin findings. Because his body was fully depigmented, his brown melanocytic macules on his face were considered as repigmentation associated with MTX treatment. His MTX treatment was stopped by patient request. On his 6-month follow-up, hypopigmentation was observed at prior repigmented macules. Methotrexate can be considered an alternative treatment for vitiligo patients when topical therapy and phototherapy are ineffective or not applicable.
白癜风是一种获得性皮肤色素脱失病，与黑素细胞破坏有关。目前文献中有少量病例报告和研究表明，甲氨蝶呤（MTX）治疗有效。一名 44 岁男性因银屑病就诊于我院，病史 1 年。皮肤科检查示双膝关节、双肘、臀及头皮处红斑、鳞屑性丘疹及斑块，符合银屑病表现。此外，全身皮肤完全色素脱失。患者有 30 年白癜风病史，起初局限，但逐渐进展，累及全身。开始予患者每周皮下注射甲氨蝶呤 10mg 治疗银屑病。甲氨蝶呤治疗第 6 周时，患者因面部新发棕色斑就诊。取自一处斑疹的皮肤活检结果报告为正常皮肤表现。由于患者全身皮肤色素脱失，其面部棕色黑素细胞斑被认为是与 MTX 治疗相关的复色。患者要求停止 MTX 治疗。6 个月随访时，先前复色的斑疹出现色素减退。当局部治疗和光疗无效或不适用时，甲氨蝶呤可作为白癜风患者的一种替代治疗方法。
