Synopsis
Select and monitor methotrexate, ciclosporin and oral retinoids for severe skin disease, prevent weekly-dose and interaction errors, interpret trends in marrow, liver, kidney, blood pressure and lipids, and apply reproductive safeguards.
- Methotrexate for inflammatory skin disease is taken once weekly on one named day, never daily; tablet strength, folic-acid day and monitoring owner must remain unambiguous.
- Methotrexate suppresses folate-dependent nucleotide synthesis and immune proliferation; marrow, liver, lung and renal-clearance toxicity make trends as important as absolute thresholds.
- Ciclosporin blocks calcineurin signalling and acts rapidly, but vasoconstrictive nephrotoxicity, hypertension, electrolyte disturbance, infection and interactions limit continuous use.
Key red flags
Fever, mouth ulceration, sore throat, bruising, bleeding, new breathlessness, jaundice, severe headache, very high blood pressure, falling urine output, rising creatinine, severe abdominal pain, visual change, pregnancy or a dosing discrepancy must interrupt routine prescribing and trigger prompt assessment.
Mouth ulcers, sore throat, fever, bruising and bleeding with falling counts can progress rapidly, especially after daily dosing, renal decline or trimethoprim exposure.
Investigation priorities
Identify marrow, liver, renal, infection, lung and reproductive contraindications.
Management branches
A conventional systemic dermatology medicine has been selected.
- Confirm disease indication, previous therapy, infection and cancer history, vaccination, pregnancy plans, alcohol, comorbidity and every interacting prescription and non-prescription product.
- Obtain the medicine-specific baseline and agree exact dose, administration, laboratory interval, symptom actions and which clinician owns each result and prescription.