June 28, 2023 – Consensus guidelines for the use of methotrexate to treat inflammatory skin diseases in pediatric patients have been published as an open access paper in the June 2023 issue of Pediatric Dermatology. Funded by a 2018 Team Grant and 2023 Study Support Grant from PeDRA, alongside support from the National Eczema Association and National Psoriasis Foundation, evidence-based guidelines were assembled by a group of experts to address discomfort with this commonly used drug. Additional support for the guidelines was provided by the PeDRA Best Practices Task Force and PeDRA Fellow.
To generate guidelines, 23 experienced clinicians formed committees to assess the current body of knowledge on indications and contraindications, dosing, interactions with immunizations and medications, adverse effects, and monitoring needs of methotrexate in pediatric populations. They addressed diseases including atopic dermatitis, psoriasis, alopecia areata, and morphea. A final list of 46 recommendations was assembled following a modified Delphi process with a 70% agreement threshold to establish consensus.
Key takeaways include recommendations that test doses and liver biopsies are unnecessary for the use of low-dose methotrexate in children, that folic acid supplementation is effective to mitigate gastrointestinal side-effects of methotrexate, and that inactivated vaccines should be administered to pediatric patients taking methotrexate.
These guidelines represent one of PeDRA’s earliest initiatives in support of its commitment to generate best practice recommendations and consensus guidelines relevant to the field of pediatric dermatology. Subsequent consensus initiatives include those dedicated to the use of retinoids for the treatment of ichthyosis, the management of pediatric mycosis fungoides, CM-AVM, pediatric vitiligo, and most recently reactive infectious mucocutaneous eruption. Investigators and project teams interested in conducting best practice recommendations and/or consensus guidelines should consider applying for a PeDRA Consensus Grant with the next anticipated deadline in early December 2023.