Eczema
Calms mild flares, including on the face.
Desonide vs Methotrexate
Desonide: A low-potency prescription steroid made for delicate skin. It is the usual step up from hydrocortisone for the face, the folds and young children. Methotrexate: An old, inexpensive tablet or injection for severe psoriasis and psoriatic arthritis. It is taken once a week, not daily, and it needs regular blood tests.
Which one is right for you?
Choose Desonide if…
Choose as the step up from hydrocortisone for delicate skin — face, eyelids, folds and babies.
- Mild eczema on the face or folds
- Hydrocortisone wasn't enough
- A young child (from 3 months)
Choose Methotrexate if…
Choose for severe psoriasis, especially with joint pain, as an inexpensive weekly treatment with regular blood tests.
- Psoriasis with psoriatic arthritis
- Cost matters and biologics aren't covered
- You can avoid alcohol and keep up blood tests
Fine together
Can you take them together?
Desonide can be used on the face or folds while taking methotrexate. They do not interact.
At a glance
● Desonide
● Methotrexate
Type
Mild topical steroid (class 6–7)
Oral or injected immune suppressant
What it does
Calms inflammation and itch
Calms overactive immune cells and skin-cell growth
Best for
Eczema on the face, folds and in young children
Severe psoriasis and psoriatic arthritis
Prescription
Yes
Yes
Form
Cream, ointment, lotion, foam
Tablet or injection
How often
Twice daily
Once a week — never daily
Course length
Up to 2 weeks on the face
Ongoing
Time to results
1–2 weeks
4–12 weeks
Main side effect
Mild stinging
Nausea and tiredness the day after
Blood tests
None
Required
Pregnancy
Check with your clinician
Never
Cost
Low; generic available
Low; generic available
What it treats
Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.
Evidence level
Desonide
Methotrexate
Strong evidenceMost established uses
Psoriasis
Clears moderate to severe plaques.
Moderate evidenceSome supportive research
Seborrheic Dermatitis
Reduces facial redness and scale.
Contact Dermatitis
Calms mild rashes.
Eczema
An option for severe eczema.
Psoriatic Arthritis
Reduces joint symptoms.
Little evidence
—
Alopecia Areata
Mixed results in small studies.
Not effective
Psoriasis
Too mild for thick plaques.
Acne
No role in acne.
Can make it worse
Perioral Dermatitis
Steroids often trigger or worsen it.
Rosacea
Steroids worsen rosacea over time.
—
How it works
Desonide
Diagram explanation and sources
Activates steroid receptors: Binds receptors inside skin and immune cells. Turns down inflammatory signals: Changes gene activity to reduce inflammatory messengers. Eases redness and itch: Swelling and irritation settle as inflammation falls.
Simplified glucocorticoid receptor-mediated effects in steroid-responsive skin inflammation. Full effects also involve other pathways. No claim of antimicrobial action or cure; formulation and potency affect clinical use.
Methotrexate
Diagram explanation and sources
Interferes with cell replication: Blocks folate-dependent processes used to make DNA. May increase adenosine signaling: This calming messenger can limit immune-cell activity. Reduces skin inflammation: Inflammatory activity and plaque buildup can decrease.
The psoriasis mechanism is not fully established. Folate antagonism affects replication, while low-dose anti-inflammatory actions include proposed adenosine pathways supported by experimental work; their precise clinical contributions are unresolved.
How you take it
Treatment plan
When to Apply: Twice a day on the affected skin only, in a thin film. One fingertip unit, the amount along the last joint of an adult index finger, covers about two adult palms. Moisturizer goes on separately and continues after the course ends.
How to Start: Twice daily from day one until the rash is flat, not just calmer, usually one to two weeks. Two weeks is the usual limit on a face, up to four weeks on the body before review. In children, follow the prescriber's duration, not the size of the tube.
If It Irritates: Stinging is usually the base, not the drug, and likelier on broken skin or with an alcohol-containing gel or foam. The ointment settles it. Redness or itch that worsens over a week or two can be allergy to the steroid or a preservative, and needs a different product.
If It Is Not Working: Two weeks of proper twice-daily use is a fair test. If nothing changed, question the diagnosis, look for infection, and ask whether the site can take a stronger steroid. On thin skin the better next step is often a non-steroid such as tacrolimus.
This drug is taken once a week. Taking it every day can cause fatal bone marrow failure. Pick one day of the week, write it down, and keep to it.
Test dose: A single small dose, often 2.5 mg to 5 mg, with blood counts checked about a week later before going further. A safety check, not the treatment dose.
Starting dose: Commonly 7.5 mg to 15 mg once weekly, adjusted for age, weight, kidney function and other illnesses. Lower in older people and in reduced kidney function.
Going up: Small steps, usually 2.5 mg to 5 mg every few weeks with blood tests in between, until the psoriasis responds or side effects set the ceiling.
Usual dose: Most people settle between 15 mg and 25 mg once weekly. Above about 15 mg tablet absorption gets unreliable, a common point to switch to the injection.
Folic acid alongside it: It reduces nausea, mouth ulcers and blood count problems. Usually a daily dose on the days you are not taking methotrexate, or one larger weekly dose on a different day. It does not stop the drug working.
Total course: No fixed course. It continues as long as it works and blood tests stay normal, which for some people is years.
Monitoring
No blood tests for a standard course in a healthy person. Monitoring is looking at the skin: did the rash clear, has the skin become thin or shiny, have small vessels or stretch marks appeared in the folds.
Children are watched more closely, not because desonide is dangerous but because they absorb proportionally more for their size. Prescribers watch how much is used per month, and whether a repeat pattern has quietly become daily use.
Low potency does not mean indefinite. Where a condition keeps flaring, the plan is short courses on flares with emollients doing the daily work, or a switch to a non-steroid such as tacrolimus or pimecrolimus for the face and folds. Around the eyes, prolonged steroid use of any potency raises the risk of glaucoma and cataract.
Methotrexate is watched by blood test, and the schedule is not optional. The problems it causes are silent until they are advanced.
Before starting: Full blood count, liver tests, kidney function, and a pregnancy test where relevant. Hepatitis B, hepatitis C, HIV and tuberculosis screening is standard, because the drug damps the immune system. A chest x-ray if there is any history of lung disease.
Early on: Blood counts and liver tests within a week or two of starting, and again after each dose increase. This is when a sudden drop in blood counts would show.
Once stable: Full blood count, liver tests and kidney function every one to three months, depending on the dose and what else you take, for as long as you are on the drug.
The liver over the long term: Years of methotrexate can scar the liver, and the risk rises with total lifetime dose, heavy alcohol use, obesity, diabetes and fatty liver disease. Biopsy used to be the check; most clinics now use a blood marker of scarring and a scan of liver stiffness.
The lungs: A rare but serious lung inflammation can occur. A new dry cough, breathlessness or fever means being seen, not waiting for the next appointment.
What to report between tests: Mouth ulcers, unexplained bruising or bleeding, sore throat or fever, dark urine, yellowing of the eyes or skin, severe nausea, any new cough or breathlessness.
When to take it
Not covered in this guide yet
Once a week, on the same day every week. Choose a day you will remember and write it somewhere visible. Some people take the whole dose at once; some split it into two portions about twelve hours apart on the same day to reduce nausea. Do not spread it across different days unless you were told to.
Take tablets with water, and with food if they upset your stomach. An evening dose means the tiredness and mild nausea happen while you are asleep.
Folic acid goes on the other days, as prescribed. It is not a substitute for a missed methotrexate dose.
With the weekly injection, keep to the same day and rotate the site.
If you miss a dose
Not covered in this guide yet
Take it as soon as you remember if it is within about two days of your usual day. If longer, skip it and take the next on your usual day. Never take two weekly doses close together to catch up, and never take a daily dose to make up for a missed week.
If you have taken more than one weekly dose, or taken it several days in a row, contact a doctor or a poison center straight away. Do not wait to see how you feel. This overdose is treatable caught early and dangerous when it is not.
When you’ll see results
Approximate windows, not promises.
● Desonide
● Methotrexate
First few minutes
First few minutesApplying it: A thin layer on the affected skin. Low potency, which suits the face, the eyelids and small children.
Days 1 to 3
Days 1 to 3Itch first: Itching and stinging settle before the rash looks different, which is often what lets a child sleep.
Days 3 to 10
Days 3 to 10Clearing: Redness fades and rough or weeping skin settles. Most facial flares are largely better here.
Weeks 1 to 2
Weeks 1 to 2Judge it here: On the face, stop and reassess here. Facial and eyelid eczema settle without the thinning risk a stronger steroid carries, and seborrheic dermatitis improves in the same window.
Weeks 1 to 2Settling in: Nothing visible in the skin yet.
Weeks 2 to 4
Weeks 2 to 4Folds and the body: Intertrigo and fold rashes respond, and the mildness suits a site that absorbs heavily; any yeast needs treating too. On the body, about four weeks before review.
After stopping
After stoppingMarks stay behind: Brown or gray patches where the rash was are pigment change, not scarring, and fade over weeks to months.
First dose
First doseTaking it: Once a week, not daily, with folic acid on the other days. Nausea, tiredness or mouth soreness in the day or two after each dose is common early on; folic acid usually blunts it.
Weeks 4 to 8
Weeks 4 to 8Working: Plaques thin and spread less, thickness and scale first. Joint pain from psoriatic arthritis often improves in the same window, one reason it is chosen over a skin-only treatment.
About 3 months
About 3 monthsJudge it here: Substantial improvement is the realistic target.
Beyond 3 months
Beyond 3 monthsLong term: Where it suits, the result holds while the dose continues, with regular blood tests. Some stay on it for years.
Many months
Many monthsNails: Nail psoriasis can improve, but slowly. Nails always lag behind the skin.
Side effects
Sorted by what to do about them.
Desonide
Methotrexate
Common
Common
- Mild stinging or burning
Common
- Nausea or tiredness the day after the dose
- Mouth sores
- Mild hair thinning
Tell your doctor
Tell your doctor
- Thin skin or visible vessels with long use
- Spots around the mouth (perioral dermatitis)
Tell your doctor
- Cough or breathlessness
- Fever, sore throat or unusual bruising
Stop and get care
Stop and get care
- Spreading rash with fever
Stop and get care
- Taking it daily by mistake
- Yellowing skin or dark urine
Safety and who should avoid it
Pregnancy
Use care
Ask the doctor managing your pregnancy.
Never
Both partners avoid conception during and for 3 months after.
Breastfeeding
Use care
Keep it off the nipple before a feed.
Never
Not compatible.
Children
3 months and older
Approved from 3 months.
Specialist only
Used in children with monitoring.
Monitoring
None
Review at 2 weeks on the face.
Required
Blood counts, liver and kidney tests; every 3 months once stable.
Key interactions
None known
—
Check
Trimethoprim-sulfamethoxazole, NSAIDs, some antibiotics; limit alcohol.
Other cautions
Avoid
Rosacea, perioral dermatitis, untreated infections.
Avoid
Liver disease, heavy drinking, kidney disease, active infection.
Cost and getting it
Getting it and cost
Generic desonide cream, ointment and lotion are cheap and well covered. The branded gel and foam, easier to use on faces and hairy areas, cost considerably more, and plans often ask for a generic first.
It costs more than over-the-counter hydrocortisone, which needs no visit, and less than non-steroids like tacrolimus or crisaborole. If cost is a barrier, start with the cream or ointment.
Generic methotrexate tablets are among the least expensive systemic treatments in dermatology. Folic acid is cheap too.
The weekly auto-injector pens cost considerably more, and coverage usually requires showing that tablets caused nausea or did not work well enough. Plain injectable vials are cheaper than the pens.
The real cost is the monitoring, repeated blood tests and periodically a liver scan or blood marker. Usually covered, but they are appointments and not optional.
Insurers frequently require a trial of methotrexate before approving a biologic, one reason it is still so often the first systemic drug tried.
When you stop
Comes back?
Eczema can flare again; moisturizer helps hold it.
Psoriasis usually returns over months.
Taper needed?
No for short courses.
Usually not, but plan the next step first.
After the last dose
Restart for flares as directed.
Wait at least 3 months before trying to conceive — applies to both partners.
Common questions
Desonide:Is desonide stronger than hydrocortisone?
Yes, by a step or two, and both are low potency. Well below mid-potency steroids like triamcinolone.
Desonide:Can I use it on my face?
That is largely what it is for. Keep courses to about two weeks and stop once the rash is flat. Repeated face use is a reason to ask about a non-steroid.
Desonide:Is it safe for my child?
A common choice in children, and some formulations are approved from a few months of age. Follow the prescriber's duration, and remember a diaper acts as a dressing.
Desonide:Will it thin my child's skin?
A short course at this potency is unlikely to. Thinning comes from stronger steroids, thin sites and long use. Untreated eczema has its own costs: months of scratching and more pigment change.
Desonide:Can it lighten skin?
It can, less readily than stronger steroids. Pale patches show more on deeper skin tones and recover slowly. Untreated inflammation also leaves light and dark marks.
Desonide:How is it different from a leftover tube of triamcinolone?
Several steps of potency. Triamcinolone on a face or in a fold for two weeks can cause thinning and stretch marks desonide would not. Matching steroid to site is why both exist.
Methotrexate:How often do I take it?
Once a week, on the same day. Never daily. Daily dosing by mistake is the most dangerous error with this drug and it has been fatal. Get medical help the same day if it happens.
Methotrexate:Why do I also have to take folic acid?
Methotrexate blocks folate, and the mouth ulcers, nausea and low blood counts come from that. Folic acid on the other days restores enough folate to reduce them without stopping the treatment working.
Methotrexate:Do I really need all the blood tests?
Yes. Liver damage and falling blood counts cause no symptoms until they are advanced. The tests are the only early warning.
Methotrexate:Can I drink alcohol?
The concern is regular drinking, not a single glass, because alcohol and methotrexate both stress the liver. Agree an actual limit with your doctor.
Methotrexate:Can I take it if I want to have a baby?
No. It must be stopped well before trying to conceive, and the advice covers both partners. It causes miscarriage and serious birth defects. Ask your own doctor how far in advance.
Methotrexate:How long before I know if it is working?
Give it about three months. First changes often show at four to eight weeks, but three months on a tolerated dose is the fair point to judge.
Methotrexate:Is it chemotherapy?
It is chemotherapy at much higher doses. At psoriasis doses it acts as an immune-calming drug, and the experience is not comparable.
Keep exploring.
Medication
Desonide
Medication
Methotrexate
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