Methotrexate is given weekly as an intramuscular injection of 15 to 25 mg. Side effects are rare and include leukopenia and hypersensitivity interstitial pneumonitis. Hepatic fibrosis is the most severe potential sequela of long-term therapy. Patients with concomitant alcohol abuse and/or morbid obesity are more likely to develop hepatic fibrosis and therefore should not be treated with methotrexate. It is prudent to obtain a baseline chest radiograph and to monitor complete blood count, liver function and renal function every two weeks until the patient is receiving oral therapy, and every one to three months thereafter. Before methotrexate therapy is initiated, the risks of treatment and the possible need for a liver biopsy should be discussed with the patient.
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In those children with allergy causing the eczema, they will usually get rashes or more extensive eczema soon after eating a particular food or drinking milk (in the case of babies). If you notice this, remove that food from your child's diet ( if you have a baby, this will need to be done under supervision with an appropriate other formula ). If there is a marked improvement on removal of the suspected food, then the food may have been the cause - cautious reintroduction of the food after 3-4 weeks will enable you to be sure. If on reintroduction of the food, the skin remains clear, the food can continue in the diet. If the skin flares up again, that food needs to be removed from the diet. In those toddlers who do have an allergy to a food causing eczema, a trial of reintroduction can be made in 6 - 12 months time as many children will grow out of these allergies.