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OBJECTIVE: To analyze the effectiveness of methotrexate (MTX) for the therapy of pediatric localized scleroderma (LS). METHODS: A retrospective chart review was performed for 17 pediatric patients with LS who failed topical therapy and were subsequently treated with MTX (12.5-25 mg weekly) with or without oral corticosteroids. A structured followup telephone call to the families was used to assess patient satisfaction. RESULTS: Skin findings improved in 16 of 17 patients with a median time to improvement of 2.25 and 2.0 months for MTX alone or in combination with corticosteroids. Only one patient had active lesions at the most recent followup visit. Fifteen of 17 families reported improvement in their child's lesions after beginning MTX. Twelve of 17 patients were treated with MTX and oral corticosteroids. There were no major adverse events. CONCLUSION: MTX appears to be a safe and effective therapy for pediatric LS.