Persistent Nasal Skin Lesions in Pemphigus Patients and the Role of Methotrexate in Treatment: A Case Series Study

Abstract

Introduction: Nasal involvement may happen infrequently, and some lesions may not respond to conventional treatments. Objectives: The current case series report aimed to describe the characteristics of 10 confirmed pemphigus vulgaris (PV) and pemphigus foliaceus (PF) patients with nasal skin lesions who did not respond to conventional treatment options or relapsed after a while and to evaluate the role of methotrexate in treatment. Methods: Data regarding patient demographics, disease type and severity, nasal lesion characteristics, and treatment response were obtained from medical records and direct communication with patients between 2019 and 2023. Results: Eight patients had received intravenous rituximab (RTX) and three had received methotrexate (MTX). Out of the eight pemphigus vulgaris (PV) patients who had undergone RTX treatment, a total of eighteen treatment sessions were carried out. Following RTX therapy, significant improvements were observed in the nasal lesions after eleven (61.1) sessions, with eight (44.4) achieving complete resolution within six months. Additionally, three patients who did not have satisfactory results after RTX treatment, received methotrexate, and all experienced complete recovery of their nasal lesions within the same timeframe. Conclusions: All the patients who benefited from methotrexate had never experienced complete remission of their nasal lesions before. It seems methotrexate can be an eligible choice for recalcitrant cases.