PENGGUNAAN METOTREKSAT PADA DERMATOSIS ANAK
DOI:
https://doi.org/10.33820/mdvi.v46i1.53Abstract
Metotreksat (MTX) merupakan antagonis asam folat yang umum digunakan sebagai terapi pada berbagai kelainan kulit, namun data mengenai penggunaan MTX pada anak masih sangat terbatas. Berdasarkan studi literatur yang telah kami lakukan, MTX menimbulkan respons klinis yang bagus dan efek samping minimal pada beberapa dermatosis anak, yaitu psoriasis, dermatitis atopik, vaskulitis, skleroderma lokalisata, dermatomiositis juvenilis, pitiriasis likenoides, sarkoidosis, penyakit bulosa autoimun, alopesia areata, dan lupus eritematosus. Secara umum toleransi anak terhadap MTX baik, dan jarang terjadi efek samping serius. Intoleransi gastrointestinal dapat terjadi, dan berespons baik terhadap pengurangan dosis obat. Berbagai pertimbangan harus dilakukan sebelum memulai terapi dengan MTX, antara lain pemeriksaan darah lengkap, fungsi hati, dan fungsi ginjal. Pemantauan terapi berupa biopsi hepar dan pemeriksaan serum type III pro-collagen aminopeptide belum rutin dilakukan. Pada telaah pustaka ini akan diulas tentang farmakologi dan farmakokinetik, mekanisme aksi, efek samping, interaksi, dan pemantauan obat MTX pada dermatosis anak. Diharapkan telaah pustaka ini akan membantu klinisi untuk mempertimbangkan pemilihan MTX dalam menatalaksana kasus-kasus dermatologi anak.
Kata kunci: metotreksat, antagonis asam folat, dermatosis anak
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References
2. Shen S, O’Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: A review. Australas J Dermatol. 2012;53:1-18.
3. Dvorakova V, O'Regan GM, Irvine AD. Methotrexate for severe childhood atopic dermatitis: Clinical experience in a tertiary center. Pediatr Dermatol. 2017;34:528-34.
4. Van Geel MJ, Oostveen AM, Hoppenreijs EP, Hendriks JCM, van de Kerkhof PCM, de Jong, EMG, dkk. Methotrexate in pediatric plaque-type psoriasis: Long-term daily clinical practice results from the Child-CAPTURE registry. J Dermatolog Treat. 2015;26:406-12.
5. Chalmers RJ. The expanding role of methotrexate for treating skin disease. Br J Dermatol. 2016;175:9-10.
6. Carretero G, Puig L, Dehesa L, Carrascosa JM, Ribera M, Sanchez-Regana M, dkk. Guidelines on the use of methotrexate in psoriasis. Actas Dermosifiliogr. 2010;101:600-13.
7. Ozdemir ZC, Turhan AB, Kar YD, Bor O. The frequency of hepatotoxicity and myelotoxicity in leukemic children with different high doses of methotrexate. Int J Pediatr Adolesc Med. 2016;3:162-68.
8. Al-Quteimat OM, Al-Badaineh MA. Practical issues with high dose methotrexate therapy. Saudi Phar J. 2014;22:385-7.
9. Gronroos MH, Jahnukainen T, Möttönen M, Perkkiӧ M, Irjala K, Salmi TT. Long-term follow-up of renal function after high-dose methotrexate treatment in children. Pediatr Blood Cancer. 2008;51:535-9.
10. Alghamdi K, Khurrum H. Methotrexate for the treatment of generalized vitiligo. Saudi Pharm J. 2013;21:423-4.
11. Puig L. Methotrexate: New therapeutic approaches. Actas Dermosifiliogr. 2014;105:583-9.
12. Gaies E, Jebabli N, Trabelsi S, Salouage I, Charfi R, Lakhal M, dkk. Methotrexate side effects: Review article. J Drug Metab Toxicol. 2012; 3:125
13. Lucas P, Bodemer C, Barbarot S, Vabres P, Royer M, Mazereeuw-Hautier J. Methotrexate in severe childhood alopecia areata: Long-term follow-up. Acta Derm Venereol. 2016;96:102-3.
14. Royer M, Bodemer C, Vabres P, Pajot C, Barbarot S, Paul C, dkk. Efficacy and tolerability of methotrexate in severe childhood alopecia areata. Br J Dermatol. 2011;165:407-10.
15. Landis ET, Pichardo-Geisinger RO. Methotrexate for the treatment of pediatric alopecia areata. J Dermatolog Treat. 2018;29:145-8.
16. Chartaux E, Joly P. Long-term follow-up of the efficacy of methotrexate alone or in combination with low doses of oral corticosteroids in the treatment of alopecia areata totalis or universalis. Ann Dermatol Venereol. 2010;137:507-13.
17. Ting TV. Diagnosis and management of cutaneous vasculitis in children. Pediatr Clin North Am. 2014;61:321-46.
18. Ruperto N, Pistorio A, Oliveira S, Zulian F, Cuttica R, Ravelli A, dkk. Prednisone versus prednisone plus
ciclosporin versus prednisone plus methotrexate in new-onset juvenile dermatomyositis: A randomised trial. Lancet. 2016;387:671-8.
19. Sag E, Batu ED, Ozen S. Childhood systemic vasculitis. Best Pract Res Clin Rheumatol. 2017;31:558-75.
20. Schram ME, Roekevisch E, Leeflang MM. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol. 2011;128:353-9.
21. Salman A, Tekin B, Yucelten D. Autoimmune bullous disease in childhood. Indian J Dermatol. 2017;62:440.
22. Pope E, Laxer RM. Diagnosis and management of morphea and lichen sclerosus and atrophicus in children. Pediatr Clin North Am. 2014;61:309–19.
23. Johnson W, Jacobe H. Morphea in adults and children cohort II: Patients with morphea experience delay in diagnosis and large variation in treatment. J Am Acad Dermatol. 2012;67:881-9.
24. Rettig P, Cron RQ. Methotrexate used as a steroid-sparing agent in non-renal chronic Henoch-Schönlein purpura. Clin Exp Rheumatol. 2003;21:767-9.
25. Lehman TJA, Edelheit BS, Onel KB. Combined intravenous methotrexate and cyclophosphamide for refractory childhood lupus nephritis. Anns Rheumatic Dis. 2004;63:321-323.
26. Weibel L, Sampaio MC, Visentin MT, Howell KJ, Woo P, Harper JI. Evaluation of methotrexate and corticosteroid for the treatment of localized scleroderma (morphoea in children). Br J Dermatol. 2006;5:1013-20.
