Localized panniculitis secondary to subcutaneous glatiramer acetate injections for the treatment of multiple sclerosis: A clinicopathologic and immunohistochemical study

Almeida, Luís Miguel Soares de; Requena, Luis; Kutzner, Heinz; Angulo, Jorge; De, J.; Pignatelli, João

doi:10.1016/j.jaad.2006.04.069

Cited by 28 publications

(34 citation statements)

References 12 publications

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“…60,61 Some case reports reported a combination of panniculitis and lipoatrophy in association with GA or with IFN-β-1b. 57,60,62 Cutaneous ulcers and necrosis Cutaneous ulcers were mainly described in patients who were treated with IFN-β-1b. A study by Webster and colleagues reported 8 (2%) out of 400 patients treated with IFN-β-1b who had developed skin ulcers.…”

Section: Lipoatrophymentioning

confidence: 99%

Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review

et al. 2012

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Glatiramer acetate and interferon-beta are approved first-line disease-modifying treatments (DMTs) for multiple sclerosis (MS). DMTs can be associated with cutaneous adverse events, which may influence treatment adherence and patient quality of life. In this systematic review, we aimed to provide an overview of the clinical spectrum and the incidence of skin reactions associated with DMTs. A systematic literature search was performed up to May 2011 in Medline, Embase, and Cochrane databases without applying restrictions in study design, language, or publishing date. Eligible for inclusion were articles describing any skin reaction related to DMTs in MS patients. Selection of articles and data extraction were performed by two authors independently. One hundred and six articles were included, of which 41 (39%) were randomized controlled trials or cohort studies reporting incidences of mainly local injection-site reactions. A large number of patients had experienced some form of localized injection-site reaction: up to 90% for those using subcutaneous formulations and up to 33% for those using an intramuscular formulation. Sixty-five case-reports involving 106 MS patients described a wide spectrum of cutaneous adverse events, the most frequently reported being lipoatrophy, cutaneous necrosis and ulcers, and various immune-mediated inflammatory skin diseases. DMTs for MS are frequently associated with local injection-site reactions and a wide spectrum of generalized cutaneous adverse events, in particular, the subcutaneous formulations. Although some of the skin reactions may be severe and persistent, most of them are mild and do not require cessation of DMT.

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Section: Lipoatrophymentioning

confidence: 99%

Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review

et al. 2012

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“…In this process vasospasms and thombogenesis can follow, which may lead to necrosis and even ulceration. Subsequent postinflammatory septal fibrosis and fat lobule atrophy cause residual lipatrophy [21]. Histological findings mostly show a lobular panniculitis with perivascular lymphocyte infiltrates similar to panniculitis induced by insulin injection or to lupus panniculitis [5,22].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shock Wave Therapy for Injection Site Panniculitis in Multiple Sclerosis Patients

Stieger

Schmid²,

Yawalkar³

et al. 2014

Dermatology

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Background: Painful cutaneous injection site reactions may hamper treatment with interferon β (IFN-β) and glatiramer acetate (GA) in multiple sclerosis (MS) patients. Objective: To maintain therapy adherence, efficient therapeutic modalities for these subcutaneous inflammatory lesions are urgently needed. We tested the application of local extracorporeal shock wave therapy (ESWT). Methods: We applied 5 sessions of ESWT to 8 patients suffering from MS who had developed painful panniculitis at the injection sites of either IFN-β or GA. Clinical outcomes, i.e. pain reduction and regression of induration, were assessed 3 and 6 months after completion of the ESWT using a visual analogue score. Results: All patients showed both significant pain reduction and reduction of the skin induration in the treated lesions, while in untreated control lesions there was no improvement. Conclusion: ESWT proved to be a non-invasive, safe and efficient physical treatment modality for injection-induced painful cutaneous side effects of disease-modifying drugs in MS.

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“…8). 87 Histopathology can orientate the diagnosis in these cases showing a mostly lobular panniculitis with lipophagic granuloma, with scattered neutrophils and eosinophils both in the septa and the fat lobules. Connective tissue septa show widening, fibrosis, and frequent lymphoid follicles with germinal center formation.…”

Section: Injected Drugsmentioning

confidence: 99%

“…In contrast, lymphoid follicles at the septa are mainly composed of B lymphocytes. 87 Injections of substances containing phosphatidylcholine to treat fat accumulation and lipomas can induce lobular neutrophilic panniculitis with necrotic adipocytes, whereas the connective tissue septa show thickening and a pseudocapsule surrounding the inflamed area. 88 Palisading granulomas with necrobiosis have been also described associated with the presence of foreign material introduced through the use of a lubricating agent containing a copolymer (Carbopol 934) for liposuction.…”

Section: Injected Drugsmentioning

confidence: 99%

Foreign Body Granulomas

Molina-Ruiz¹,

Requena²

2015

Dermatologic Clinics

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Localized panniculitis secondary to subcutaneous glatiramer acetate injections for the treatment of multiple sclerosis: A clinicopathologic and immunohistochemical study

Cited by 28 publications

References 12 publications

Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review

Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review

Extracorporeal Shock Wave Therapy for Injection Site Panniculitis in Multiple Sclerosis Patients

Foreign Body Granulomas

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