Comment related to the publication ‘‘Elevation of transaminases after MMP® session with methotrexate for alopecia areata treatment – How much do we know about the risks of systemic absorption of the technique?’’ – Answer^★

Dear Editor,

We agree with the consideration that, regarding the cause of the increase in transaminase levels in the described patient, there are no means of affirming with certainty the association with the MMP® technique.¹ We reinforce, however, that she had already shown an elevation of transaminase levels with the previous use of the medication when administered orally. We attributed it to the technique used after excluding other possible causes such as infections, alcohol consumption, physical activity, or use of any other medication, in addition to the transitoriness of transaminitis in relation to the procedure.

The technique involves the penetration of needles into the dermis,²,³ where vascularization is prominent in the scalp, with biological plausibility in affirming the possibility of absorption of the drug used. Additionally the patient is likely to be susceptible to methotrexate-related adverse effects, despite the small, absorbed dose.

We reaffirm the importance of reporting unexpected adverse effects related to the recent use of percutaneous treatment techniques, aiming at patient safety through adequate monitoring.

• ★
  Study conducted at the Service of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
• Financial support
  None declared.

References

• ¹
  Nogueira BL, Bonamigo RR, Heck R. Elevation of transaminases after MMP® session with methotrexate for alopecia areata treatment - how much do we know about the risks of systemic absorption of the technique? An Bras Dermatol. 2023;98:390–1, http://dx.doi.org/10.1016/j.abd.2021.01.013
  » http://dx.doi.org/10.1016/j.abd.2021.01.013
• ²
  Arbache S, de Mendonca MT, Arbache ST, Hirata SH. Treatment of idiopathic guttate hypomelanosis with a tattoo device versus a handheld needle. JAAD Int. 2021;3:14–6.
• ³
  Arbache S, Mattos EC, Diniz MF, Paiva PYA, Roth D, Arbache ST, et al. How much medication is delivered in a novel drug delivery technique that uses a tattoo machine? Int J Dermatol. 2019;58:750–5.

Publication Dates

• Publication in this collection
  22 Jan 2024
• Date of issue
  Jan-Feb 2024

History

• Received
  14 Aug 2023
• online
  23 Sept 2023