A 24-year-old woman presents to the physician for follow up of longstanding psoriasis which has been unresponsive to topical corticosteroids. Vital signs are blood pressure is 127/78 mmHg, heart rate 62 beats/minute, and respirations 18/minute. Physical examination reveals erythematous, sharply-defined papules and plaques with silvery scale on the knees and elbows. Methotrexate is prescribed.
Which of the following supplements should be prescribed with methotrexate?
A) Folate
B) Iron
C) Niacin
D) Riboflavin
E) Thiamine
A) Folate
Patients with chronic plaque psoriasis develop erythematous, sharply demarcated plaques with silvery scale typically located on the extensor surfaces. Histopathology shows an inflammatory infiltrate with epidermal acanthosis, hyperkeratosis, as well as expansion of rete ridges. Patients may also experience arthritis. Mild psoriasis is managed with topical corticosteroids and vitamin D. Severe disease typically requires UV phototherapy and methotrexate. Methotrexate inhibits dihydrofolate reductase, causing a decrease in pyrimidine synthesis and thus causes immunosuppression. Adverse effects of methotrexate use include bone marrow suppression, renal impairment, oral mucositis, pulmonary pneumonitis and fibrosis, and folate deficiency. Patients treated with methotrexate should be supplemented with folate.
Key Learning Point
Patients treated with methotrexate should be receive folate supplementation.
