BACKGROUND: After decades of use, methotrexate displays an established safety and efficacy profile in both in-hospital and outpatient settings. Despite its widespread use, there is surprisingly little clinical evidence to guide daily practice with methotrexate in dermatology.
OBJECTIVE: To provide guidance for clinicians in daily practice for areas in which there is limited guidance.
METHODS: A Delphi consensus exercise on 23 statements was carried out on the use of methotrexate in dermatological routine settings.
RESULTS: Consensus was reached on statements that cover six main areas: (1) pre-screening exams and monitoring of therapy; (2) dosing and administration in patients naïve to methotrexate; (3) optimal strategy for patients in remission; (4) use of folic acid; (5) safety; and (6) predictors of toxicity and efficacy. Specific recommendations are provided for all 23 statements.
CONCLUSIONS: In order to optimize methotrexate efficacy, it is essential to optimize treatment using appropriate dosages, carrying out a rapid drug-based step-up on a treat-to-target strategy and preferably using the subcutaneous formulation. To manage safety aspects appropriately, it is essential to evaluate patients\' risk factors and carry out proper monitoring during the course of treatment.

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Side-effects of adjuvant endocrine therapy (AET) are common in breast cancer survivors, and can affect adherence to treatment. We synthesised the evidence for strategies to self-manage these side-effects.
We searched for systematic reviews and clinical guidelines on self-management strategies for AET side-effects (arthralgia, fatigue, hot flashes, gastrointestinal discomfort, nausea, vulvovaginal symptoms, and sleep disturbance). We searched oncology organisation\'s websites and eight databases (Inception-November 2020). Screening, data extraction and quality assessment were completed independently in duplicate.
2019CRD4201914001.
We identified 33 systematic reviews and 18 clinical guidelines. 21% of reviews were high quality, and the average quality score for guidelines was 44%. Evidence for most strategies was absent or weak. There was consensus from a low-quality review and multiple guidelines to recommend moisturisers, gels and lubricants for vulvovaginal symptoms. Evidence was weak for physical activity for self-managing most symptoms, although two high-quality reviews indicated yoga and aerobic exercise could reduce fatigue. Primary research was often biased by weak and underpowered study designs. Eleven reviews did not report information on adverse events.
Most self-management strategies for breast cancer survivors experiencing side-effects from AET lack evidence. Primary research is needed using high-quality well-powered designs focusing on implementable strategies.
Patients and clinicians should be aware that although the risk of harm is low for these self-management strategies, the likelihood of benefit is often unclear. Women should consider moisturisers, gels or lubricants for self-managing vulvovaginal symptoms, and yoga or aerobic exercise for alleviating fatigue.

The number of kinesiology tape\'s users is increasing year by year. However, the insufficiency of fundamental knowledge about the appropriate usage of kinesiology tapes can generate undesired side-effects caused by incorrect application of kinesiology tapes and/or denouncement of kinesiology tapes as an ineffective practice. Therefore, it is necessary to arrange a set of general guidelines of kinesiology taping that must be followed. If not, the treatment may have to be ceased due to the side-effects such as skin\'s troubles. Another problem, which impeaches effectivity of treatment by kinesiology tapes, is focusing solely on the present area of pain or discomfort. However, such solution is only short-termed and the likelihood of reappearance of the pain is remarkably high. Therefore, it is essential to find and eliminate the origin of the problem. If these fundamentals conditions of tape\'s application are satisfied, the treatment by kinesiology tapes may bring us far more better results.