Intralesional Methotrexate Safe, Efficacious in Localized Vitiligo Lesions

Intralesional methotrexate injections were safe and effective in patients with localized vitiligo lesions.

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In a recent study,¹ researchers sought to determine the efficacy of the drug in patients with vitiligo, citing the condition’s involvement in targeting epidermal melanocytes and the varied efficacy of available treatment modalities.

Researchers recruited 30 patients, 23 females and 7 males, with localized vitiligo lesions, for participation in the study. Of these participants, 4 had a demonstrated family history of the condition. On average, patients were 33.6 ± 8.6 years of age with a disease duration ranging from 1 to 22 years.

Every 2 weeks, researchers administered intralesional injections of methotrexate. All participants underwent a maximum of 6 injection sessions.

The study’s primary endpoint was degree of repigmentation, and researchers found that participants had a high statistical significance of repigmentation improvement.

This is not the first time that methotrexate has been considered for vitiligo treatment.

In 1998, the first incidence of methotrexate treatment for vitiligo was reported via a case report,² wherein a female patient presented with widespread depigmentation. After receiving a once-weekly dose of methotrexate for 3 months, she presented with a reduction in depigmented lesions and considerable repigmentation.

In 2013, a team of researchers conducted a study³ investigating the effects of methotrexate in patients with generalized vitiligo. The prospective pilot study involved 6 patients with a minimum body surface area of 6%. However, clinical and imaging assessments did not show any change in vitiligo lesions, though the treatment was well-tolerated.

Again in 2017, researchers conducted a study⁴ similar to the one conducted in 2013, wherein patients with vitiligo were treated with a low dosage of methotrexate for 11 to 16 months. 3 patients presented with clinically significant repigmentation, with 1 patient seeing results as early as 6 months.

“This study showed that intralesional methotrexate is a safe and effective treatment option for patients with localized vitiligo lesions,” the recent study authors wrote. “Further studies on a larger scale are needed to evaluate the long-term effects of treatment and detect the ideal dose to be injected.”

References

1. Elrewiny EM, Shawky A, Mohamed SF, Ammar AM, Mansour M, Rageh MA. Intralesional methotrexate in the treatment of localized vitiligo: A pilot study. Aust J Dermatol. Published online 2023. doi:10.1111/ajd.14071
2. Sandra A., Pai S., Shenoi S.D. Unstable vitiligo responding to methotrexate. Indian J Dermatol. VenereolLeprol. 1998;64(6):309.
3. Alghamdi K, Khurrum H. Methotrexate for the treatment of generalized vitiligo. Saudi Pharm J. 2013;21(4):423-424. doi:10.1016/j.jsps.2012.12.003
4. Garza-Mayers AC, Kroshinsky D. Low-dose Methotrexate for Vitiligo. J Drugs Dermatol. 2017;16(7):705-706.