Study on the treatment effectiveness of low-dose methotrexate combined with topical corticosteroids for moderate to severe psoriasis at Hue Central Hospital

Objectives: To investigate the efficacy of low-dose methotrexate combined with topical corticosteroids and the side effects of low-dose methotrexate in patients with moderate to severe psoriasis. Methods: A descriptive, retrospective study of 31 patients diagnosed with moderate to severe psoriasis treated with a combination of low-dose methotrexate and topical corticosteroids at the Dermatology Department of Hue Central Hospital from January 2019 to June 2022. Results: 74.2% of the patients were over 50 years old, with females accounting for 58.1%. 80.6% had a disease duration of over 5 years. Erythematous plaques and scaling were prevalent, distributed across the chest, abdomen, back, and limbs. 77.4% had severe disease, with the psoriasis vulgaris and pustular forms accounting for 32.3%. Obesity and older age were the two highest risk factors. 67.7% used ultra-potent corticosteroids, 90.3% received subcutaneous methotrexate, 58.1% started with a dose of 5–10 mg/week, and 74.2% maintained a dose of 10–15 mg/week, with 45.2% using folic acid. After 4 weeks, PASI75 was achieved in 38.7%, and 87.1% showed a significant reduction in PASI levels. There was a statistically significant correlation between the rate of achieving PASI75 and age group as well as disease duration (p-values < 0.05). 3.2% experienced abdominal pain, and 6.5% had elevated liver enzymes. Conclusions: The study results indicate that the combination therapy of low-dose methotrexate and topical corticosteroids helps improve clinical status in patients with moderate to severe psoriasis. The adverse effects reported were primarily abdominal pain and mild liver enzyme elevation, which did not impact treatment. However, due to the short follow-up period and low cumulative dose of methotrexate, the study could not fully assess other potential adverse events.