A study has raised concerns about the potential risks of using Traditional Chinese Medicine (TCM) in the treatment of psoriasis, particularly when it contains methotrexate (MTX), a widely used immunosuppressive agent. The research aimed to determine whether MTX in TCM could increase the risk of skin ulcers in patients with psoriasis.
The study retrospectively reviewed the medical records of five patients who developed painful skin ulcers at primary psoriatic sites after taking TCM. The researchers evaluated several indicators, including hemocytopenia (low blood cell count), liver function, serum MTX levels, and ABCB1 gene polymorphisms, which can affect drug metabolism. Histopathological examinations of the ulcerative tissue samples were also conducted.
The results revealed that two of the patients developed hemocytopenia, while two others showed abnormal liver function. Serum MTX levels ranged from 0.03 to 0.11 μmol/L in two of the patients, remaining under 0.1 μmol/L at 72 hours after MTX administration. Additionally, two patients were found to have different ABCB1 gene polymorphisms (AA and AG). Histopathological examination showed signs of keratinocyte dyskeratosis (abnormal development of skin cells), dermal vasodilation (enlarged blood vessels), and inflammatory cell infiltration in the affected skin tissue.
Three of the patients were treated with oral folic acid, which led to complete healing of their skin lesions within two weeks. The other two patients showed gradual improvement after discontinuing TCM.
The study concluded that while rare, TCM containing MTX may contribute to skin ulceration in psoriasis patients. This highlights the need for careful monitoring when using TCM in psoriasis treatment, especially when MTX is involved.
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