Methotrexate for the treatment of patients with chronic cutaneous sarcoidosis: 4 cases

Introduction. Pathogenesis of sarcoidosis remains partially unknown. Cutaneous lesions are frequent (20 to 35 % of cases). Their clinical features and follow-up data are highly variable. Numerous treatments have been proposed. The clinical features and follow up data of four patients with chronic cutaneous sarcoidosis treated with methotrexate are reported. Case report. Mean age of patients (3 female, 1 male) was 40 years old (34-49 years). One patient presented with a lupus pernio, two patients with papules and nodules, and the last with an annular lesion of the face. All patients had been previously treated with topical corticosteroids and/or hydroxychloroquine without any success. Patients were treated with methotrexate at doses ranging from 12.5 mg to 30 mg per week for at least 6 months. Complete remission of cutaneous lesions was observed in 3 of 4 patients after a mean treatment duration Of 29 months (16 to 36). Methotrexate side effects were observed in one patient (elevated liver enzymes) leading to methotrexate discontinuation. Discussion. Methotrexate seems to be an effective treatment of cutaneous sarcoidosis. it should be used namely in patients who failed to respond to previous treatments with topical corticosteroids or antimalarial drugs.