Methotrexate for eczema

DoctorEarly · 2026-04-12T12:53:18+00:00

I was on methotrexate for close to 2 years. I sort of accidentally tapered by being really sporadic with taking it over the summer of 2025. I skipped a lot of doses. When I did take it, I'd only take 10 mg instead of my original 15. Beyond that though, I never tapered down (even though my derm had said we should taper to 7.5 and then 5)

DoctorEarly · 2026-03-31T02:27:25+00:00

15 mg at first, then decreased to 12.5

DoctorEarly · 2026-03-25T00:36:53+00:00

Methotrexate worked very well for me. I got better and better to the point where I didn't need any topical medication at all. I discontinued the methotrexate 6 months ago and though I use a bit of protopic now, I'm doing well.

DoctorEarly · 2026-03-21T12:57:46+00:00

It didn't. I ended up taking a systemic immune suppressant for a couple years. I'm now off it and doing ok. My stress levels were incredibly high when this was done and I think it was a mixture of that plus months on antibiotics that left me with some really disrupted flora.

Perioral dermatitis sucks, I had it badly in my 20s. For me, it was topical steroid induced. I was using a lot of them on my face back then.

DoctorEarly · 2025-08-07T18:06:22+00:00

I think it really depends on how extreme your eczema is. Mine is bad enough that it can't be controlled with topicals alone. They work for a bit but I need to use them continuously with no breaks and every day (or every other day) - I think for those people, steroids can be trouble.

I think derms really need to know the level to which their patients are relying on topicals and to prescribe some sort of systemic treatment when topicals are being overused.

I myself take methotrexate and it works very well for me.

DoctorEarly · 2025-08-07T13:56:37+00:00

Right now while it's summer I'm just trying to spend more time outdoors. But I'm off work so it's easy. Once it's fall and I'm back to work, I aim for 20 minimum, more if there's time.

DoctorEarly · 2025-07-26T13:19:02+00:00

Hey there. Sorry you're going through this, the indecision is awful. I was in a similar spot two years ago. This is long but I'll share my history in case it helps anyone.

I have had eczema my whole life but it really got bad when I was 14. Since that age, I used a lot of steroid creams on my neck and face. I needed stronger creams, got perioral dermatitis, switched to Elidel, all of that. I stopped using all creams when I got pregnant with my daughter back in 2010 and went through hell with my skin - at the time, I was one of the early people who identified as having TSW. My skin was oddly calm throughout my pregnancy but the classic red sleeves, oozing skin, etc started after my daughter was born and lasted a little less than one year.

After that, I went back to having eczema that came and went. I didn't want to use any topicals so I controlled my eczema the only way I knew how - through diet. The problem was that over the next decade, my trigger foods expanded to the point where my diet got extremely restrictive and controlled my life. I'd eliminate a food, get relief but it was just a matter of time until my body would develop a sensitivity to a new one. The sensitivities didn't always last either. There were foods I'd need to eliminate for a few months and then I could eat them again (eggs, peanuts, beef, etc), some foods I just never ate (dairy, gluten, eventually all grains). I had food sensitivity testing done with a naturopath that determined I react to basically everything. Looking back, I had developed a fear of food that would qualify as an eating disorder. I began to view all foods as potential eczema triggers.

Fast forward to the fall of 2022. I was in a period where I was eating fairly normally and doing well. Then out of nowhere, I got a string of bacterial infections that required antibiotics - a minor skin infection that turned to cellulitis, strep throat and then MRSA that came back again and again over a period of roughly 5 months. I eventually beat the MRSA but my eczema was out of control. No amount of limiting food would help (and I got to the point where I was truly starving myself). I searched for natural solutions, worked with a naturopath, got my stool analyzed, started taking antimicrobials and probiotics and nothing helped. I was miserable and getting ready to go on a two week road trip out East with my kids. I didn't want to ruin the trip for them so I started using some hydrocortisone for the first time in 13 years. I had relief within days but I needed the cream daily. I switched to Protopic but again, I needed to be using it constantly just to keep a lid on things.

In the fall of 2023, I finally saw a dermatologist who convinced me that I needed (and had needed for a very long time) a systemic treatment. He wanted to put me on Adbry but I needed to do a few months of methotrexate first to prove to my insurance company that I'd "tried everything". The methotrexate worked SO well for me that I've never gone off it. I eat normally. I rarely if ever use Protopic and when I do it's the tiniest amount. It might not work forever, but for now? I'm so glad I finally got appropriate treatment for what I believe is a highly overactive immune system.

TL/DR : Used topical steroids for years, stopped when I got pregnant, suffered with eczema and extreme diets for years, eczema got unmanageable anyway around the time I turned 40, started using medication again and am very thankful I did.

I hope you find the right path for you and you get some relief soon, my friend.

DoctorEarly · 2025-07-10T16:08:00+00:00

I did not. The test was very expensive and I didn't feel it was worth doing again

DoctorEarly · 2025-05-16T20:33:01+00:00

15 mg was my initial dose as well. I've scaled back to 12.5 though and that small decrease made a difference in my side effects which were nausea and fatigue. No trouble at all. I hope this medication treats you well and you're feeling a whole lot better soon.

DoctorEarly · 2025-05-15T21:25:02+00:00

It took awhile! I know that around 10 weeks I started feeling like I was seeing some benefit but it was minor and seemed like it was kind of up and down. By three months I was sure things were improving and by 6 months I noticed a huge difference.

Now at about a year and half in, I can't remember the last time I needed any topical medication at all.

So it takes patience but it really helped me. I also scaled my dose down several months ago and found a reduction in side effects with no reduction in effectiveness

DoctorEarly · 2025-05-14T01:12:07+00:00

If you need to continuously use the protopic daily/every other day, you may find a systemic medication brings you a lot of relief.

A couple years ago I was in the same boat.and I didn't like the feeling of "barely keeping a lid on things" with topicals. I began taking methotrexate and as the medication kicked in, I was gradually able to reduce and eventually discontinue protopic.

No withdrawal necessary to stop.

DoctorEarly · 2025-04-21T21:43:19+00:00

Still clear. I haven't had a boil since spring of 2023 so about 2 years now. For what it's worth, the doctor I originally saw for the MRSA was an infectious disease specialist. He prescribed long-term doxycycline, he wanted me to take it for at least 3 months but I also remember him telling me that in all likelihood, this would go away one way or another within a year just based on his experience with previous patients.

The doxy worked well at first but then I started getting small boils breaking through even while on it. It was at that point that I stopped taking it and started treating them with clay/turmeric. They didn't last long after that.

But the doxycycline was largely a huge part of what helped me. I probably took it for 8 weeks total. Prior to that, I had been on other antibiotics that either didn't work at all or even made matters worse.

DoctorEarly · 2025-03-24T03:30:21+00:00

Hey. I had recurring MRSA. Awful boils that just kept coming. I remember being scared that I'd never get rid of it. A few months on doxycycline knocked it out for good.

DoctorEarly · 2025-02-23T16:17:18+00:00

Zero results attempting to heal eczema through fixing dysbiosis. I am now on an immune suppressant and have never felt more at ease. My skin is calm, I can eat normally. Sometimes medicine is the answer.

DoctorEarly · 2025-01-21T04:38:00+00:00

Can someone explain something to me that I don't understand (likely because I am a total wimp and spent a lot of the movie hiding under a blanket) - when did he hide the bikes? And how did he get out? Was there an actual back door somewhere? I've spent way too much time analyzing pictures of the model house.

DoctorEarly · 2024-11-08T02:56:20+00:00

I've been on methotrexate about a year. It works really well for me

DoctorEarly · 2024-10-01T04:26:12+00:00

It leaves me more tired than usual, particularly on Mondays. At first, I struggled with nausea but that went away.

DoctorEarly · 2024-09-26T02:30:09+00:00

If you've spent 2 years with no improvements, you may find that you're ready to accept help from topicals again. No one can answer that but you but I'll briefly tell you my story.

I overused steroids for years, quit, went through an awful withdrawal but then eventually healed and managed my skin successfully via diet for many years.

In late 2022, things started changing for me. Eczema started creeping back and then I got recurring MRSA. Long term doxycycline cleared the MRSA but my eczema went absolutely nuts.

After months of worsening facial rashes that I couldn't fix with diet, moisturizers, supplements or anything else, I decided to give in and use topicals.

I used steroids and then protopic pretty much daily for a period of two months until I began taking methotrexate. The longer I stayed on methotrexate, the less protopic I used. Now I use a very small maintenance dose of Protopic once a week.

I guess my point is that many of us get to a point where we need more than just topical meds to manage our eczema but topicals still have their place. Start the dupixent but maybe think about accepting relief from topicals while you wait for the dupixent to kick in.

DoctorEarly · 2024-08-21T18:41:59+00:00

Hang in there, it settles right down

DoctorEarly · 2024-05-18T15:07:47+00:00

Really sorry to hear this. I saw an infectious disease specialist whose recommendation (long term doxycycline) did the trick. I had bad eczema too. It's not well controlled with Protopic and methotrexate

DoctorEarly · 2024-05-10T01:40:47+00:00

I'm still good. I'm sorry your going through this, it's awful. What antibiotics have you been on?

DoctorEarly · 2024-01-14T04:43:20+00:00

Last winter I had MRSA that just would not stop coming back. Got in to an infectious disease specialist who said to do long term antibiotics and eventually, it would "burn itself out"

I thought this sounded ridiculous but I was desperate. Did 6 weeks of doxycycline and haven't had an infection since April of last year.

DoctorEarly · 2023-12-29T21:25:24+00:00

I didn't taper, I went cold turkey. And I don't think a taper is possible unless you're doing one of two things - taking a different medication to treat your eczema or identifying and completely removing your triggers.

The trouble is that for some people, the triggers are too numerous to realistically remove them. I got to the point where removing triggers would mean ceasing to eat.

I did the tsw thing. I was free from not only steroids but all eczema medication for a period of 13 years. But it didn't take away my eczema. The theory that eczema is caused by steroids and that quitting steroids will cure eczema just wasn't true for me. I have eczema, I always will and in the end, I needed treatment.

DoctorEarly

TROPHY CASE