MTX

Methotrexate (MTX) is a systemic immunosuppressant.

MTX can have many side effects. That list doesn't discuss dosage or duration of treatment, which leaves unknown whether lower dosages and/or shorter duration could improve LS symptoms while minimizing risks of side effects.

Trying multiple anti-infectant topicals would be advised before MTX, because if an infection is playing a role, using MTX to suppress the immune system could temporarily remove the symptoms, but allow that infection to grow.

Patient experiences

Patient experience 1 This male patient's LS symptoms went away when he used MTX.

I have been on the immune suppressant known as MTX since January. I am male around 200lbs and am taking 5mg once per week, with 1mg Folic Acid the other six days.

The white inelastic skin tone is 98% gone, phimosis gone completely, I am still sensitive to most soaps though.

I wound up at a leading dermatologist after getting a plaque reaction. I thought it could have been a reaction to taking probiotics. as it was different that anything I had noticed before. My LS improved significantly in 4 weeks time since starting the MTX tablets. I waited to make sure it worked before posting about it, as all previous ointments seemed to work until they didn't. I am surprised to not see mention of this here before.

Oh, the areas that look like scar tissue fade and go away too. (Source.)

(His account hasn't posted again, so it's unknown if it was a permanent cure in his case.)

Dosage

This patient's doctor prescribed her 20mg per week. That is 400% the 5mg per week dosage that removed the above patient's symptoms.

More patient experiences. https://groups.io/g/LichenSclerosis/search?q=Methotrexate+OR+MTX