Methotrexate (also referred to by the brand names Jylamvo, Metrex, Methofill, Metoject, Nordimet and Zlatal) belongs to the group of medicines known as 'systemics' in the treatment of psoriasis. It is also used to treat psoriatic arthritis and many other conditions such as rheumatoid arthritis and Crohn's disease in both children and adults.
Methotrexate has been used since the 1970's in the treatment of moderate to severe psoriasis who have not had a good response from, or are unsuitable for, topical treatments (treatments that are applied to the skin) or ultraviolet light therapy. It is also used for psoriasis that is widespread.
When prescribed for psoriatic arthritis, Methotrexate is known as a ‘Disease Modifying Anti-Rheumatic Drug’ (DMARD).
Methotrexate works by regulating the body’s immune system and helping to reduce swelling or inflammation. It also slows down the production of skin cells that multiply so rapidly in psoriasis.
Methotrexate is usually taken in tablet form once a week, on the same day each week. Sometimes it is taken as a liquid that you swallow, or as an injection, also once a week. Methotrexate should never be taken daily.
Methotrexate can only be prescribed by a Dermatology or Rheumatology Specialist who is responsible for your care. They will usually prescribe a very low dose at first, which will be gradually increased. Once the methotrexate is working well, which can take between 1-3 months, the dose will be adjusted to the lowest level capable of maintaining the improvement that has been achieved.
People taking methotrexate will have regular blood tests - usually carried out by Dermatology Nurses, or by their own GP - to monitor possible effects of the treatment. These are required weekly at first, or when the dose is being altered, but once the dose of methotrexate is stable, monitoring tests are carried out every 2-3 months. People taking methotrexate should have an annual flu vaccination, but should check with a doctor or nurse before having any other vaccinations or taking other medication.
Methotrexate is often used on its own to treat psoriasis or psoriatic arthritis, however it is sometimes used in conjunction with other medications, such as biologics, in order to help the other medication work more effectively by preventing the body from building up antibodies.
There are lots of other medications that can interact with methotrexate, including over-the-counter products such as aspirin and ibuprofen, and certain vitamins or supplements. Anyone taking methotrexate should ensure that they tell their Dermatologist or Rheumatologist about all medications, over-the-counter products and supplements that they are taking, and should not take anything new without checking with their doctor or a Pharmacist first.
As with all medications, some side effects are possible when taking methotrexate. It is important to remember that not every person taking a medication will get all, or even any, of the possible side effects listed. The most common side effects of methotrexate are often managed by lowering or splitting the dose, which should be discussed with your healthcare team first.
Kidney and liver
The main risk of long-term methotrexate use is the potential for liver or kidney damage, which will be closely monitored with regular blood tests by your Dermatologist/Rheumatologist.
Sun sensitivity
Your skin may also be more sensitive to the sun while you are taking methotrexate. Stay out of bright sun and use a high factor sun cream (SPF 30 or above) with protective clothing, even on cloudy days. Do not use a sun lamp or sun beds.
Immune system
Because methotrexate works by reducing the activity of the immune system, it can make people taking it more prone to infections than they usually would be. If a serious infection occurs a doctor will most likely stop treatment with methotrexate. You should let your doctor know as soon as possible if you notice signs or symptoms of an infection, such as a raised temperature, fever or sore throat.
The immune system also protects against cancer, and it is thought that treatment with low doses of methotrexate may increase the risk of developing lymphomas (cancer that starts in the immune system). If this happens, treatment with methotrexate will be stopped. Sometimes, the lymphoma will resolve itself after methotrexate is stopped, whereas in other cases it will need to be treated.
Folic acid
You may be prescribed folic acid tablets while you're taking methotrexate, as they can help reduce some of the side effects, as well as protecting the healthy cells in your body.
The doctor who prescribes your medications will advise you when to take the folic acid. You must not take it on the same day as your methotrexate, as it can stop it from working properly.
If you have any concerns before starting methotrexate, please talk to your Dermatologist, Rheumatologist or Clinical Nurse Specialist before starting treatment.
If you have been prescribed methotrexate for treatment of your psoriasis, you may be asked to take part in the British Association of Dermatologists Biologics Interventions Register (BADBIR). This register is to compare the safety of different treatments for psoriasis and to see how well they work.
The information on this page is also available in our methotrexate information sheet.
February 2026 (Review date: February 2029)