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Seventy patients with psoriasis severe enough to require methotrexate therapy were evaluated to assess the effects of the drug on both liver function and histology. Thirty-five patients had not received methotrexate (untreated) and 35 patients had previously received methotrexate (treated). A total of 102 liver biopsies were performed in these 70 patients. A review of the liver biopsy specimens showed no statistically significant differences in the histologic changes between the treated and untreated patients. The lack of reliable correlation between the liver function tests and the histologic findings noted in previous studies was confirmed in this study. In the 35 untreated patients, nondiagnostic changes were seen in the liver biopsies of 28 patients (80%) and significant fibrosis in only 1 patient (3%). No biopsy showed cirrhosis. In the 35 treated patients, nondiagnostic changes were seen in 2.5 patients (71%), significant fibrosis in 2 patients (6%), and cirrhosis in 1 patient (3%). Thirty-two repeat biopsies in 21 patients showed no progression in the fibrosis scores up to a period of 27 months of therapy. thus raising doubts about the necessity of performing routine liver biopsies in those patients receiving methotrexate on an intermittent regimen. [ABSTRACT FROM AUTHOR]