Methotrexate (MTX) has been recognized not only as an anchor drug in rheumatoid arthritis (RA) treatment, but also as a standard drug for psoriasis in Western countries. In Japan, MTX for psoriasis treatment had not been approved; however, in March 2018, the Evaluation Committee on Unapproved or Off-Labeled Drugs with High Medical Needs of the Ministry of Health and Welfare acknowledged its high medical need, and in Mmm 2019, MTX for psoriasis treatment was approved as a public knowledge-based application. In this article, we summarize the utilization pattern of MTX as psoriasis treatment in Japan as well as the safety measures implemented in RA in order to ensure safety in patients with psoriasis.
Nine cases of eosinophilic fasciitis (EF) were retrospectively investigated. Eight cases were females, and their initial symptoms were lower leg edema in all of them. These female cases were presented to our hospital within 20 days after they noticed the symptom, which quickly disappeared without causing skin sclerosis after steroid therapy. In one male patient, who first arrived at our hospital more than one year after the initiation of the edema, skin sclerosis was already evident in his extremities and trunk, and steroid therapy did not improve his symptoms. Serum thymus and activation-regulated chemokaine (TARC) levels were markedly high in all the five cases examined. They were significantly reduced to the normal levels after the steroid therapy in four steroid-responded cases.
These results suggested that early introduction of steroid therapy is critical for preventing irreversible skin sclerosis and that serum TARC levels could be a useful clinical biomarker in EF.