Hidradenitis Suppurativa
The first approved treatment.
Humira vs Methotrexate
Humira: An injected biologic for moderate to severe plaque psoriasis. It blocks TNF, one of the main inflammation signals behind psoriasis, and is usually given as a shot under the skin every other week. 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 Humira if…
Choose for moderate to severe psoriasis or hidradenitis suppurativa — the first approved biologic for HS, now with cheaper biosimilars.
- Psoriasis or HS not controlled by creams or tablets
- Joint pain from psoriatic arthritis too
- No active TB or serious infections
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
Often combined
Can you take them together?
Often used together. Low-dose methotrexate can help Humira keep working by preventing antibodies against it.
At a glance
● Humira
● Methotrexate
Type
Biologic injection (adalimumab, TNF blocker)
Oral or injected immune suppressant
What it does
Blocks TNF, a main inflammation signal
Calms overactive immune cells and skin-cell growth
Best for
Psoriasis, hidradenitis suppurativa, psoriatic arthritis
Severe psoriasis and psoriatic arthritis
Prescription
Yes
Yes
Form
Injection under the skin
Tablet or injection
How often
Every other week (weekly for HS)
Once a week — never daily
Course length
Ongoing
Ongoing
Time to results
12–16 weeks
4–12 weeks
Main side effect
Injection-site reactions; infections
Nausea and tiredness the day after
Blood tests
TB and hepatitis tests before starting
Required
Pregnancy
Check with your clinician
Never
Cost
High; biosimilars 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
Humira
Methotrexate
Strong evidenceMost established uses
Psoriasis
Clears moderate to severe plaques.
Psoriatic Arthritis
Reduces joint damage.
Psoriasis
Clears moderate to severe plaques.
Moderate evidenceSome supportive research
—
Psoriatic Arthritis
Reduces joint symptoms.
Eczema
An option for severe eczema.
Little evidence
—
Alopecia Areata
Mixed results in small studies.
Not effective
Eczema
Doesn't target eczema inflammation.
Acne
No role in acne.
Can make it worse
Melanoma
May slightly raise skin cancer risk.
—
How it works
Humira
Diagram explanation and sources
Binds TNF: Captures an immune messenger that promotes inflammation. Reduces inflammatory signaling: TNF has less ability to activate its receptors. Lets inflamed skin settle: Conditions such as psoriasis can improve over time.
Adalimumab binds TNF-alpha and inhibits its interaction with p55/p75 TNF receptors. This image focuses on skin inflammation; Humira also has other indications.
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
Adults are not dosed by body weight. You start with a larger loading dose to get levels up fast, then settle into an every-other-week rhythm.
Starting dose: 80 mg on day one, as one 80 mg injection or two 40 mg injections at different spots.
One week later: 40 mg.
Usual dose: 40 mg every other week, the same day of the week each time.
If it stops working: Some people move to weekly injections, others switch drugs. The prescriber's call.
Other conditions: Hidradenitis suppurativa uses a heavier loading dose and weekly maintenance, so do not assume a friend's schedule matches yours.
How long: Long term, with no set course length. It continues while it works and is tolerated.
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.
When to take it
Any time of day, but pick a set day of the week and keep to it. Every other week is easy to lose track of, so set a phone reminder on day one.
Take the pen or syringe out of the fridge 15 to 30 minutes before injecting. Cold liquid stings more. Do not warm it in the microwave or hot water.
Inject into the front of the thigh or the belly, at least two inches from the navel. Rotate the spot each time, and avoid skin that is bruised, red, hard, tender or scarred. Never inject through a plaque. A nurse or pharmacist should train you in person for the first dose. Used pens go in a sharps container, never the household bin.
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
Inject as soon as you remember, then return to your original schedule rather than shifting future doses. Never inject two doses to catch up. If you have missed more than one dose, call the prescriber before restarting — long gaps can blunt how well it works.
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.
Monitoring
Everyone is screened for tuberculosis before the first dose — a skin test or TB blood test, often with a chest X-ray. TNF blockers can wake a dormant TB infection, so a positive screen is treated first and adalimumab waits until that treatment is under way. Testing is often repeated yearly, or sooner if you live somewhere TB is common.
Hepatitis B and C are checked too, because hepatitis B can reactivate when the immune signal is blocked.
After that there is no fixed blood test schedule like methotrexate's. Many doctors check a blood count and liver tests occasionally. Most monitoring is clinical — how the skin looks, and whether you are getting more infections than usual.
Skin should be checked periodically, because TNF blockers are linked to a small increase in skin cancer. The label also carries a boxed warning about serious infections and about lymphoma and other cancers, based mostly on rare cases in children and young adults. The absolute risk is low, but it is why this prescription gets regular review.
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 you’ll see results
Approximate windows, not promises.
● Humira
● Methotrexate
First few minutes
First few minutesThe injection: A sting for a few seconds. Injection site reactions, if they happen, show up in the first weeks.
Weeks 1 to 4
Weeks 1 to 4Starting: Itching often eases before the plaques look different, and some people see the scale thin early.
Weeks 4 to 12
Weeks 4 to 12Working: Plaques flatten, scale lifts and redness fades from the middle outward. Most of the visible change happens here. Psoriatic arthritis improves on a similar timeline, and hidradenitis suppurativa settles to fewer painful lumps on its own heavier schedule.
Week 16
Week 16Judge it here: The point the trials measured. Most people reached at least a 75 percent improvement in skin involvement and severity, and a smaller share cleared almost completely.
Months 6 to 12
Months 6 to 12Nails: The slowest, because a nail takes months to grow out. Pitting and lifting improve well after the skin has settled.
After the first year
After the first yearLong term: Most people who respond keep responding.
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 1 to 2
Weeks 1 to 2Settling in: Nothing visible in the skin yet.
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.
Humira
Methotrexate
Common
Common
- Injection-site redness or itch
- Cold-like infections
- Headache
Common
- Nausea or tiredness the day after the dose
- Mouth sores
- Mild hair thinning
Tell your doctor
Tell your doctor
- Persistent cough, weight loss or night sweats
- New rash or psoriasis on palms and soles
Tell your doctor
- Cough or breathlessness
- Fever, sore throat or unusual bruising
Stop and get care
Stop and get care
- Fever with signs of serious infection
- Swelling of face or throat
Stop and get care
- Taking it daily by mistake
- Yellowing skin or dark urine
Safety and who should avoid it
Pregnancy
Use care
Often continued with planning; ask the doctor managing your pregnancy.
Never
Both partners avoid conception during and for 3 months after.
Breastfeeding
Use care
Generally considered compatible; confirm with your clinician.
Never
Not compatible.
Children
OK
Approved in children for several conditions.
Specialist only
Used in children with monitoring.
Monitoring
Sometimes
TB and hepatitis B tests before starting.
Required
Blood counts, liver and kidney tests; every 3 months once stable.
Key interactions
Check
Avoid live vaccines; other biologics.
Check
Trimethoprim-sulfamethoxazole, NSAIDs, some antibiotics; limit alcohol.
Other cautions
Avoid
Active infection, TB, heart failure, multiple sclerosis.
Avoid
Liver disease, heavy drinking, kidney disease, active infection.
Cost and getting it
Getting it and cost
The list price is very high, tens of thousands of dollars a year. Almost nobody pays that. What you pay depends on your insurance, and getting there takes paperwork.
Prior authorization is close to universal. Most plans require you to have tried and failed something cheaper first — phototherapy, methotrexate or another systemic drug — and they want records to prove it.
Biosimilars changed the picture. Several have been sold in the United States since 2023, some at much lower list prices. Which one you get is usually decided by your plan's formulary, not your dermatologist, and plans switch year to year. A switch is a paperwork event, not a medical downgrade, though you may need retraining on a different pen.
Manufacturer copay cards can bring the cost down to very little with commercial insurance. By law they cannot be used with Medicare or Medicaid. For those plans, or with no insurance, manufacturer and foundation assistance programs are the usual route, and their rules change often.
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?
Psoriasis and HS usually return over months.
Psoriasis usually returns over months.
Taper needed?
No.
Usually not, but plan the next step first.
After the last dose
Restarting can work, but some people respond less well the second time.
Wait at least 3 months before trying to conceive — applies to both partners.
Common questions
Humira:What does biologic actually mean?
A large protein grown in living cells rather than a factory chemical. That is why it is injected, and why it lives in the fridge.
Humira:Does the injection hurt?
A sharp sting for a few seconds. Letting it warm to room temperature first makes a real difference, and citrate-free versions sting less than the original.
Humira:How long before I know if it is working?
Some change by 4 weeks, and about 16 weeks before you judge it fairly. If nothing has happened by then, talk about switching.
Humira:Can I still have vaccines?
Yes, apart from live ones. The flu shot, COVID, pneumonia vaccines and Shingrix are fine and usually recommended. Have live vaccines before you start.
Humira:What do I do if I catch a cold or need antibiotics?
A simple cold is usually not a reason to skip a dose. Anything with a fever, or needing antibiotics, should be checked with the prescriber first.
Humira:Is a biosimilar as good as Humira?
It must be shown to have no clinically meaningful difference from the original. The pen changes; what is inside does the same job.
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.
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Humira
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Methotrexate
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