By Gary M. White, MD

Methotrexate-Induced Epidermal Necrosis (MIEN) is a rare toxic side effect of methotrexate use and mimics stevens johnson syndrome/TEN with widespread erosions.


Widespread erosions, skin detachment and mucosal erosions are typical.

Differential Diagnosis

SJS/TEN would show target lesions. Skin biopsy can help differentiate.


Stopping the methotrexate and rapid infusion of leucovorin are indicated. Leukopenia is a poor prognostic sign.


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