Psoriasis treatment: Unconventional and non-standard modalities in the era of biologics

Table 5 Grading of Liver biopsy as per Roenigk scale and recommendations for further methotrexate therapy

Biopsy grade	Liver histopathologic findings	Recommendation
I	Normal; fatty infiltration, nuclear	May continue methotrexate
	Variability and portal inflammation- mild
II	Fatty infiltration, nuclear variability, portal tract expansion, inflammation and necrosis- moderate to severe
IIIA	Fibrosis-mild	May use methotrexate with caution and repeat biopsy at 6 mo
IIIB	Fibrosis-moderate to severe	Should not be given except in exceptional circumstances
IV	Cirrhosis