INTRODUCTIONPsoriasis is a chronic papulosquamous skin disease that has a prevalence ranging from 0.1% to 1.5% and may present at any age.1Its rare variant, juvenile-onset pustular psoriasis, is a recalcitrant disease with a unique immunopathogenesis and morphology, unlike its more prevalent plaque-type counterpart and is often resistant to conventional systemic therapy.2, 3Methotrexate is a drug that has cytotoxic, anti-inflammatory and immune-modulatory activities that provide clinical benefits in the therapy of psoriasis.4