Patient Name: Adela Torres
Patient ID: 132463
Consultant: Sachi Kato, MD, Dermatology
Requesting Physician: Leon Medina, MD Internal Medicine
Date of Consult: 06/23/12
Reason for Consult: Previous evaluated stomatitis, possibly methotrexate related.
HISTORY OF PRESENT ILLNESS: The patient is a very pleasant 57-year-old female, a native of Cuba, being seen for evaluation and treatment for sores in her mouth that she had for the last 10 to 12 days. The patient has a long history of severe and debilitating rheumatoid arthritis for which she has had numerous treatments, but over the past 10 years she has been treated with methotrexate quite successfully. Her dosage has varied somewhere between 20 and 25 …show more content…
RECCOMENDED THERAPY: I agree with your therapeutic regimen regarding this condition with the use of prednisone and folic acid. I also agree that the methotrexate must be discontinued in order to produce a resolution of this patient’s skin problem. However in my experience the stomatitis may take a number of weeks to go away completely if a patient has been on methotrexate for an extended period of time, because the medication is stored within the liver and fatty tissue. Topically, I have prescribed Lidex