On to Methotrexate

We all wish to have our skin magically clear and be flare-free for the rest of our lives. Most of the time, it doesn't happen this way. In 2013, I tried cyclosporine. In 2022, I tried Dupixent (dupilumab). Now, I am trying methotrexate.

What is Methotrexate?

It's safe to assume that many are unfamiliar with this drug. It was never intended as a treatment for eczema or any other skin condition. It was first meant to treat cancer.¹

In the 1940's, a researcher named Sidney Farber discovered that by blocking folic acid, you could slow the spread of leukemia. Methotrexate boomed onto the scene as one of the first chemotherapy drugs due to its effective nature in blocking folic acid.¹

It was only by accident that cancer patients with psoriasis began noticing the added beneficial effect that methotrexate had on their skin. Because it is an immunosuppressive drug, it dampened their immune response to skin triggers.^2,3

Henceforth, time and research have been invested in using this drug for skin conditions, such as eczema.

How does it rate against other drugs for eczema?

Both cyclosporine and methotrexate are full immune suppressors. Cyclosporine is faster in taking effect than methotrexate.⁴ They've been around for a long time now and are the first step in being allowed to use other drugs. In the United States, this may fluctuate depending on your insurance and needs. In the UK, we must try and "fail" these drugs before being allowed to graduate to more concentrated drugs like biologics and JAK inhibitors.

Biologics

Biologics, like Dupixent (dupilumab) and Adbry (tralokinumab), are highly targeted treatments. Instead of suppressing our entire immune system, they block certain IL (interleukin) pathways that cause inflammation. Dupixent targets two of them (IL-4 and IL-13 ) and tralokinumab targets one (IL-13).⁵

JAK inhibitors

JAK inhibitors are the  newest treatment on the block - Janus kinase inhibitors such as Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib), Jakafi (ruxolitinib), Cibinqo (abrocitinib), and Litfulo (ritlecitinib). They fall somewhere in between immunosuppressants and biologics, not fully suppressing the immune system but less targeted than biologics. They block the activity of JAK enzymes, which can cause inflammation in the body.⁶

How safe are these drugs?

Cyclosporine and Methotrexate: I've never been partial to taking an immunosuppressive simply because it dampens the entire immune system.⁷ That means your immune system is weakened against infections and you need to be cautious when taking certain drugs, like ibuprofen. Also, cyclosporine can be harsh on the kidneys (why I had to come off in 2013), while methotrexate can be hard on the liver (no drinking).^8,9 Both also require blood tests to ensure each organ is holding steady.

Dupixent and Adbry: I felt safe testing out Dupixent because it was highly targeted. However, after a year, I began having the eye issues (conjunctivitis) and the red facial flares that happen to some on the drug. This worrying and newest side effect that has been popping up for a few patients is Dupilumab-induced psoriatic eruption -- which basically means you'll enjoy double the trouble of both eczema and psoriasis.¹⁰

JAK inhibitors: Honestly, these drugs are still so new, some of their side effects trouble me.

What have I tried?

Now, this is where I sit as a patient. I've tried not only those drugs mentioned in the beginning, but other healing methods.

I've tried:

• Traditional Chinese Medicine
• Stem Cell Therapy
• Allergy testing
• Different diets (including IgG sensitivity testing)

Some of these just didn't work. And right now, I am suffering. The mental toll being physically unwell takes on someone who is ten years into a battle with Topical Steroid Withdrawal is tough. I've had people share their concerns about immunosuppressives with me and that I should continue to heal naturally.

But this is an individual choice we must all make for ourself. If you are in my boat, know you are not alone. It's your choice and yours alone.

Where am I at with my treatment journey now?

This is week 5 of my journey on methotrexate. It is a once weekly pill (or in my case, injection). I am at 15mg, which is the usual starting dosage.¹¹ I don't wish to move up to any larger dose if I do not see it helping. It may be another 3 weeks before I start to see some changes, sometimes even longer on the drug.

My wish is to try the next biologic drug, but I had to do this before being allowed. Crossing my fingers that I receive some relief. And crossing fingers for all of you.