Methotrexate-induced epidermal necrosis

A patient with erythrodermic psoriasis is described who developed epidermal necrosis due to methotrcxate. Concurrent salicylate administration and borderline renal failure interfered with methotrexate elimination, leading to an elcvated plasma methotrexate concentration 36 h aftcr the methotrexate administration. Although the epidermal necrosis is sometimes thought to be idiosyncratic, the present case suggcsts that it may be a dose‐related problem.