We found no RCTs but one controlled trial of methotrexate in systemic lupus. Carneiro and Sato in their double-blind study reported that 12 of 20 patients in the active arm and 16 of 21 in the placebo arm had cutaneous lesions, declining to three in the active arm but remaining unchanged in the placebo group.77 The skin lesions and outcome measures are not described. We found small observational studies and case reports describing improvement in skin lesions of lupus.78-86

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