Methotrexate in Pediatric Dermatology: An Old Acquaintance, New Certainties

Methotrexate (MTX) is a well-established treatment in pediatric dermatology for inflammatory and immune-mediated diseases, such as psoriasis, severe atopic dermatitis, morphea, and alopecia areata. This review highlights MTX's efficacy and safety at low doses (0.2 to 1 mg/kg/week), making it a first-line therapeutic option. Regular monitoring of blood count and liver and renal function is necessary to prevent complications, and folic acid supplementation can mitigate adverse effects. Despite the rise of biologic therapies, MTX remains a cost-effective and accessible treatment with strong clinical support for pediatric patients.