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However, despite widespread off\u2010label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off\u2010label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence\u2010 and consensus\u2010based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence\u2010 and consensus\u2010based recommendations, each with &gt;70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence\u2010 and consensus\u2010based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time\u2010honored medication.<\/jats:p>","DOI":"10.1111\/pde.15327","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T22:23:57Z","timestamp":1686781437000},"page":"789-808","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Methotrexate for inflammatory skin disease in pediatric patients: Consensus treatment guidelines"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4794-9905","authenticated-orcid":false,"given":"Elaine C.","family":"Siegfried","sequence":"first","affiliation":[{"name":"SSM Cardinal Glennon Children's Hospital  St. Louis Missouri USA"},{"name":"Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Arkin","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2869-2718","authenticated-orcid":false,"given":"Yvonne E.","family":"Chiu","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelaide A.","family":"Hebert","sequence":"additional","affiliation":[{"name":"UTHealth McGovern Medical School at Houston  Houston Texas United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Callen","sequence":"additional","affiliation":[{"name":"University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Castelo\u2010Soccio","sequence":"additional","affiliation":[{"name":"The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"University of Pennsylvania Perelman School of Medicine, The University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic O.","family":"Co","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Cordoro","sequence":"additional","affiliation":[{"name":"University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan L.","family":"Curran","sequence":"additional","affiliation":[{"name":"Children's Hospital Colorado University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin M.","family":"Dalrymple","sequence":"additional","affiliation":[{"name":"SSM Cardinal Glennon Children's Hospital  St. Louis Missouri USA"},{"name":"Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Flohr","sequence":"additional","affiliation":[{"name":"Department of Paediatric Dermatology St John's Institute of Dermatology, Guy's &amp; St Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken B.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Hanna","sequence":"additional","affiliation":[{"name":"Modern Dermatology  Shawnee Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9048-2044","authenticated-orcid":false,"given":"Alan D.","family":"Irvine","sequence":"additional","affiliation":[{"name":"Trinity College Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Kim","sequence":"additional","affiliation":[{"name":"University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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