Liver Ultrastructure in Methotrexate Treatment of Psoriasis

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Abstract
To the Editor.— Methotrexate, a folic acid antagonist, is widely used in the treatment of psoriasis, since it is capable of controlling widespread lesions refractory to other therapeutic measures. In the course of medication, various side-effects, including hepatotoxicity, have been reported; it was claimed that chronic use of the drug may lead to fibrosis and cirrhosis of the liver.1,2 In the present study, livers of nine patients with psoriasis that were treated with methotrexate have been investigated by light and electron microscopy. To our knowledge, similar ultrastructural studies have not been reported so far. Four patients were men and five were women. Their ages ranged from 26 to 74 years. The dose of methotrexate used, the duration of treatment, the time of liver biopsy, and the extent of skin lesions varied from patient to patient. With the consent of the patients, percutaneous liver biopsies were performed with the use