Methotrexate and Healing

Photo of an open wound on the writer's upper back. Caption reads: "The wound was open."

Methotrexate and Healing lupus-related blog post by Iris Carden

I can’t be the only lupus patient who has ever been told that methotrexate will stop wounds from healing. That’s not thought to be true any more.

This is a tale of two skin cancer excisions.

About a decade ago, I had a basal cell carcinoma (bcc) removed from my nose. Since it was right in the middle of my face, my general practitioner (gp) referred me to the plastic surgery clinic at a major public hospital.

On the day the excision was meant to take place, they staff looked at my medication list and decided they could not do it. They insisted I had to stop taking my methotrexate before they could do the excision, or it would not heal.

I complied with their instructions. (There was a cancer in the middle of my face, what else could I do?) The minor surgery to remove the bcc happened, and it did heal, although with a huge lump on my nose. Sure the lump’s disfiguring, but it’s very handy for resting my glasses on.

I’ve spent my life in what’s known as the “skin cancer capital of the world”, and I take methotrexate which is linked to a higher risk of skin cancer. Of course, I was going to get more.

About a fortnight ago, my current gp excised a bcc from my upper back. This time I wasn’t told to stop methotrexate, which surprised me.

I looked it up, because I’m a curious kind of person, and found recent research suggests that low dose methotrexate (such as used for lupus and rheumatoid arthritis) doesn’t actually affect healing after all. That was a relief. I always worry about messing with a medication regime that is mostly working.

Ten days after the excision, my wound was declared nicely healed, and the stitches were carefully removed. During the day, may back hurt around the excision site, and I put it down to the stitches being removed and thought it would get better quickly.

I thought that until I took my shirt off that night and saw I had blood in it. My daughter checked for me and the whole wound had re-opened. She dressed it that night, and I went back to the doctor’s surgery in the morning.

The wound can’t be re-stitched. It has to just be left to heal. While it heals, I need to go to the doctor’s surgery twice a week to have the dressing changed, and have my daughter change dressings in between visits.

So why did the wound re-open if not for the methotrexate? The doctor’s explanation is that it’s a matter of placement. The wound was high on my back, near the shoulder. There’s a lot of muscle movement in that area. The fresh join in the skin just couldn’t withstand all that movement. Basically, I was just unlucky.


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By Iris Carden

Iris Carden is an Australian indie author, mother, grandmother, and chronic illness patient. On good days, she writes. Because of the unpredictability of her health, she writes on an indie basis, not trying to meet deadlines. She lives on a disability support pension now, but her ultimate dream is to earn her own living from her writing.

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