LymphedemaV1, Istex, Corpus, bibRecord, 001045

Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management

Identifieur interne : 001045 ( Istex/Corpus ); précédent : 001044; suivant : 001046

Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management

Auteurs : E M Frohman ; K. Brannon ; Sherry Alexander ; D. Sims ; J T Phillips ; S. O'Leary ; K. Hawker ; M K Racke

Source :

Multiple Sclerosis [ 1352-4585 ] ; 2004-06.

RBID : ISTEX:239CC14D65231835D5D426C8C23A0A116CE30470

Abstract

Background: The objective for this article is to highlight some of the adverse skin manifestations associated with injectable disease modifying therapy for multiple sclerosis (MS). Early identification and intervention can often lead to minimal consequences and prolonged patient tolerance and compliance with these agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available disease modifying agents (DMA s). O ur experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. Conclusion: Skin reactio ns in response to injectable DMA therapy in MS are generally mild. However, some reactio ns can evolve into potentially serious lesions culminating in infection, necro sis, and in some circumstances requiring surgical repair.

Url:

https://api.istex.fr/document/239CC14D65231835D5D426C8C23A0A116CE30470/fulltext/pdf

DOI: 10.1191/1352458504ms1002oa

Links to Exploration step

ISTEX:239CC14D65231835D5D426C8C23A0A116CE30470

Le document en format XML

<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
<author wicri:is="90%"><name sortKey="Frohman, E M" sort="Frohman, E M" uniqKey="Frohman E" first="E M" last="Frohman">E M Frohman</name>
<affiliation><mods:affiliation>Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,</mods:affiliation>
</affiliation>
<affiliation><mods:affiliation>E-mail: elliot.frohman@utsouthwestern.edu</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Brannon, K" sort="Brannon, K" uniqKey="Brannon K" first="K" last="Brannon">K. Brannon</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Alexander, Sherry" sort="Alexander, Sherry" uniqKey="Alexander S" first="Sherry" last="Alexander">Sherry Alexander</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Sims, D" sort="Sims, D" uniqKey="Sims D" first="D" last="Sims">D. Sims</name>
<affiliation><mods:affiliation>Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Phillips, J T" sort="Phillips, J T" uniqKey="Phillips J" first="J T" last="Phillips">J T Phillips</name>
<affiliation><mods:affiliation>Baylor University Medical Center, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="O Leary, S" sort="O Leary, S" uniqKey="O Leary S" first="S" last="O'Leary">S. O'Leary</name>
<affiliation><mods:affiliation>Baylor University Medical Center, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Hawker, K" sort="Hawker, K" uniqKey="Hawker K" first="K" last="Hawker">K. Hawker</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Racke, M K" sort="Racke, M K" uniqKey="Racke M" first="M K" last="Racke">M K Racke</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, the Center for Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">ISTEX</idno>
<idno type="RBID">ISTEX:239CC14D65231835D5D426C8C23A0A116CE30470</idno>
<date when="2004" year="2004">2004</date>
<idno type="doi">10.1191/1352458504ms1002oa</idno>
<idno type="url">https://api.istex.fr/document/239CC14D65231835D5D426C8C23A0A116CE30470/fulltext/pdf</idno>
<idno type="wicri:Area/Istex/Corpus">001045</idno>
<idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001045</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
<author wicri:is="90%"><name sortKey="Frohman, E M" sort="Frohman, E M" uniqKey="Frohman E" first="E M" last="Frohman">E M Frohman</name>
<affiliation><mods:affiliation>Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,</mods:affiliation>
</affiliation>
<affiliation><mods:affiliation>E-mail: elliot.frohman@utsouthwestern.edu</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Brannon, K" sort="Brannon, K" uniqKey="Brannon K" first="K" last="Brannon">K. Brannon</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Alexander, Sherry" sort="Alexander, Sherry" uniqKey="Alexander S" first="Sherry" last="Alexander">Sherry Alexander</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Sims, D" sort="Sims, D" uniqKey="Sims D" first="D" last="Sims">D. Sims</name>
<affiliation><mods:affiliation>Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Phillips, J T" sort="Phillips, J T" uniqKey="Phillips J" first="J T" last="Phillips">J T Phillips</name>
<affiliation><mods:affiliation>Baylor University Medical Center, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="O Leary, S" sort="O Leary, S" uniqKey="O Leary S" first="S" last="O'Leary">S. O'Leary</name>
<affiliation><mods:affiliation>Baylor University Medical Center, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Hawker, K" sort="Hawker, K" uniqKey="Hawker K" first="K" last="Hawker">K. Hawker</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
<author wicri:is="90%"><name sortKey="Racke, M K" sort="Racke, M K" uniqKey="Racke M" first="M K" last="Racke">M K Racke</name>
<affiliation><mods:affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, the Center for Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</mods:affiliation>
</affiliation>
</author>
</analytic>
<monogr></monogr>
<series><title level="j">Multiple Sclerosis</title>
<idno type="ISSN">1352-4585</idno>
<idno type="eISSN">1477-0970</idno>
<imprint><publisher>Sage Publications</publisher>
<pubPlace>Sage CA: Thousand Oaks, CA</pubPlace>
<date type="published" when="2004-06">2004-06</date>
<biblScope unit="volume">10</biblScope>
<biblScope unit="issue">3</biblScope>
<biblScope unit="page" from="302">302</biblScope>
<biblScope unit="page" to="307">307</biblScope>
</imprint>
<idno type="ISSN">1352-4585</idno>
</series>
<idno type="istex">239CC14D65231835D5D426C8C23A0A116CE30470</idno>
<idno type="DOI">10.1191/1352458504ms1002oa</idno>
<idno type="ArticleID">10.1191_1352458504ms1002oa</idno>
</biblStruct>
</sourceDesc>
<seriesStmt><idno type="ISSN">1352-4585</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass></textClass>
<langUsage><language ident="en">en</language>
</langUsage>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Background: The objective for this article is to highlight some of the adverse skin manifestations associated with injectable disease modifying therapy for multiple sclerosis (MS). Early identification and intervention can often lead to minimal consequences and prolonged patient tolerance and compliance with these agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available disease modifying agents (DMA s). O ur experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. Conclusion: Skin reactio ns in response to injectable DMA therapy in MS are generally mild. However, some reactio ns can evolve into potentially serious lesions culminating in infection, necro sis, and in some circumstances requiring surgical repair.</div>
</front>
</TEI>
<istex><corpusName>sage</corpusName>
<keywords><teeft><json:string>interferon</json:string>
<json:string>subcutaneous</json:string>
<json:string>skin reactions</json:string>
<json:string>multiple sclerosis</json:string>
<json:string>intramuscular</json:string>
<json:string>abscess</json:string>
<json:string>sclerosis</json:string>
<json:string>injection technique</json:string>
<json:string>adverse events</json:string>
<json:string>injection</json:string>
<json:string>medical center</json:string>
<json:string>site reactions</json:string>
<json:string>injection sites</json:string>
<json:string>injection therapy</json:string>
<json:string>room temperature</json:string>
<json:string>acad dermatol</json:string>
<json:string>cutaneous necrosis</json:string>
<json:string>skin necrosis</json:string>
<json:string>injection site reactions</json:string>
<json:string>higher predilection</json:string>
<json:string>surgical incision</json:string>
<json:string>case report</json:string>
<json:string>glatiramer acetate</json:string>
<json:string>adverse skin manifestations</json:string>
<json:string>skin reaction</json:string>
<json:string>injection site</json:string>
<json:string>subcutaneous injection therapy</json:string>
<json:string>skin surface</json:string>
<json:string>multiple sclerosis study group</json:string>
<json:string>necrotic skin lesion</json:string>
<json:string>unclear reasons</json:string>
<json:string>topical steroids</json:string>
<json:string>necrosis</json:string>
</teeft>
</keywords>
<author><json:item><name>E M Frohman</name>
<affiliations><json:string>Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,</json:string>
<json:string>E-mail: elliot.frohman@utsouthwestern.edu</json:string>
</affiliations>
</json:item>
<json:item><name>K Brannon</name>
<affiliations><json:string>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
<json:item><name>Sherry Alexander</name>
<affiliations><json:string>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
<json:item><name>D Sims</name>
<affiliations><json:string>Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
<json:item><name>J T Phillips</name>
<affiliations><json:string>Baylor University Medical Center, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
<json:item><name>S O'Leary</name>
<affiliations><json:string>Baylor University Medical Center, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
<json:item><name>K Hawker</name>
<affiliations><json:string>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
<json:item><name>M K Racke</name>
<affiliations><json:string>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, the Center for Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</json:string>
</affiliations>
</json:item>
</author>
<subject><json:item><lang><json:string>eng</json:string>
</lang>
<value>abscess</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>erythema</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>glatiramer acetate</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>interferon beta</value>
</json:item>
<json:item><lang><json:string>eng</json:string>
</lang>
<value>necrosis</value>
</json:item>
</subject>
<articleId><json:string>10.1191_1352458504ms1002oa</json:string>
</articleId>
<language><json:string>eng</json:string>
</language>
<originalGenre><json:string>research-article</json:string>
</originalGenre>
<abstract>Background: The objective for this article is to highlight some of the adverse skin manifestations associated with injectable disease modifying therapy for multiple sclerosis (MS). Early identification and intervention can often lead to minimal consequences and prolonged patient tolerance and compliance with these agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available disease modifying agents (DMA s). O ur experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. Conclusion: Skin reactio ns in response to injectable DMA therapy in MS are generally mild. However, some reactio ns can evolve into potentially serious lesions culminating in infection, necro sis, and in some circumstances requiring surgical repair.</abstract>
<qualityIndicators><score>4.729</score>
<pdfVersion>1.4</pdfVersion>
<pdfPageSize>580 x 795 pts</pdfPageSize>
<refBibsNative>true</refBibsNative>
<abstractCharCount>1065</abstractCharCount>
<pdfWordCount>2357</pdfWordCount>
<pdfCharCount>16121</pdfCharCount>
<pdfPageCount>6</pdfPageCount>
<abstractWordCount>156</abstractWordCount>
</qualityIndicators>
<title>Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
<genre><json:string>research-article</json:string>
</genre>
<host><title>Multiple Sclerosis</title>
<language><json:string>unknown</json:string>
</language>
<issn><json:string>1352-4585</json:string>
</issn>
<eissn><json:string>1477-0970</json:string>
</eissn>
<publisherId><json:string>MSJ</json:string>
</publisherId>
<volume>10</volume>
<issue>3</issue>
<pages><first>302</first>
<last>307</last>
</pages>
<genre><json:string>journal</json:string>
</genre>
</host>
<categories><wos><json:string>science</json:string>
<json:string>clinical neurology</json:string>
</wos>
<scienceMetrix><json:string>health sciences</json:string>
<json:string>clinical medicine</json:string>
<json:string>neurology & neurosurgery</json:string>
</scienceMetrix>
<inist><json:string>sciences appliquees, technologies et medecines</json:string>
<json:string>sciences biologiques et medicales</json:string>
<json:string>sciences medicales</json:string>
<json:string>pathologie infectieuse</json:string>
</inist>
</categories>
<publicationDate>2004</publicationDate>
<copyrightDate>2004</copyrightDate>
<doi><json:string>10.1191/1352458504ms1002oa</json:string>
</doi>
<id>239CC14D65231835D5D426C8C23A0A116CE30470</id>
<score>1</score>
<fulltext><json:item><extension>pdf</extension>
<original>true</original>
<mimetype>application/pdf</mimetype>
<uri>https://api.istex.fr/document/239CC14D65231835D5D426C8C23A0A116CE30470/fulltext/pdf</uri>
</json:item>
<json:item><extension>zip</extension>
<original>false</original>
<mimetype>application/zip</mimetype>
<uri>https://api.istex.fr/document/239CC14D65231835D5D426C8C23A0A116CE30470/fulltext/zip</uri>
</json:item>
<istex:fulltextTEI uri="https://api.istex.fr/document/239CC14D65231835D5D426C8C23A0A116CE30470/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
</titleStmt>
<publicationStmt><authority>ISTEX</authority>
<publisher>Sage Publications</publisher>
<pubPlace>Sage CA: Thousand Oaks, CA</pubPlace>
<availability><p>SAGE</p>
</availability>
<date>2004</date>
</publicationStmt>
<sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
<author xml:id="author-1"><persName><forename type="first">E M</forename>
<surname>Frohman</surname>
</persName>
<email>elliot.frohman@utsouthwestern.edu</email>
<affiliation>Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,</affiliation>
</author>
<author xml:id="author-2"><persName><forename type="first">K</forename>
<surname>Brannon</surname>
</persName>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</author>
<author xml:id="author-3"><persName><forename type="first">Sherry</forename>
<surname>Alexander</surname>
</persName>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</author>
<author xml:id="author-4"><persName><forename type="first">D</forename>
<surname>Sims</surname>
</persName>
<affiliation>Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</author>
<author xml:id="author-5"><persName><forename type="first">J T</forename>
<surname>Phillips</surname>
</persName>
<affiliation>Baylor University Medical Center, Dallas, TX, USA</affiliation>
</author>
<author xml:id="author-6"><persName><forename type="first">S</forename>
<surname>O'Leary</surname>
</persName>
<affiliation>Baylor University Medical Center, Dallas, TX, USA</affiliation>
</author>
<author xml:id="author-7"><persName><forename type="first">K</forename>
<surname>Hawker</surname>
</persName>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</author>
<author xml:id="author-8"><persName><forename type="first">M K</forename>
<surname>Racke</surname>
</persName>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, the Center for Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</author>
</analytic>
<monogr><title level="j">Multiple Sclerosis</title>
<idno type="pISSN">1352-4585</idno>
<idno type="eISSN">1477-0970</idno>
<imprint><publisher>Sage Publications</publisher>
<pubPlace>Sage CA: Thousand Oaks, CA</pubPlace>
<date type="published" when="2004-06"></date>
<biblScope unit="volume">10</biblScope>
<biblScope unit="issue">3</biblScope>
<biblScope unit="page" from="302">302</biblScope>
<biblScope unit="page" to="307">307</biblScope>
</imprint>
</monogr>
<idno type="istex">239CC14D65231835D5D426C8C23A0A116CE30470</idno>
<idno type="DOI">10.1191/1352458504ms1002oa</idno>
<idno type="ArticleID">10.1191_1352458504ms1002oa</idno>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><creation><date>2004</date>
</creation>
<langUsage><language ident="en">en</language>
</langUsage>
<abstract xml:lang="en"><p>Background: The objective for this article is to highlight some of the adverse skin manifestations associated with injectable disease modifying therapy for multiple sclerosis (MS). Early identification and intervention can often lead to minimal consequences and prolonged patient tolerance and compliance with these agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available disease modifying agents (DMA s). O ur experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. Conclusion: Skin reactio ns in response to injectable DMA therapy in MS are generally mild. However, some reactio ns can evolve into potentially serious lesions culminating in infection, necro sis, and in some circumstances requiring surgical repair.</p>
</abstract>
<textClass><keywords scheme="keyword"><list><head>keywords</head>
<item><term>abscess</term>
</item>
<item><term>erythema</term>
</item>
<item><term>glatiramer acetate</term>
</item>
<item><term>interferon beta</term>
</item>
<item><term>necrosis</term>
</item>
</list>
</keywords>
</textClass>
</profileDesc>
<revisionDesc><change when="2004-06">Published</change>
</revisionDesc>
</teiHeader>
</istex:fulltextTEI>
<json:item><extension>txt</extension>
<original>false</original>
<mimetype>text/plain</mimetype>
<uri>https://api.istex.fr/document/239CC14D65231835D5D426C8C23A0A116CE30470/fulltext/txt</uri>
</json:item>
</fulltext>
<metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration>
<istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType>
<istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spmsj</journal-id>
<journal-id journal-id-type="publisher-id">MSJ</journal-id>
<journal-title>Multiple Sclerosis</journal-title>
<issn pub-type="ppub">1352-4585</issn>
<publisher>                 
            <publisher-name>Sage Publications</publisher-name>                 
            <publisher-loc>Sage CA: Thousand Oaks, CA</publisher-loc>             
         </publisher>
</journal-meta>
<article-meta><article-id pub-id-type="doi">10.1191/1352458504ms1002oa</article-id>
<article-id pub-id-type="publisher-id">10.1191_1352458504ms1002oa</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>Disease modifying agent related skin reactions in multiple sclerosis:                 prevention, assessment, and management</article-title>
</title-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Frohman</surname>
<given-names>E M</given-names>
</name>
<aff>Department of Neurology, University of Texas Southwestern Medical Center                         at Dallas, Dallas, TX, USA, Department of Radiology, University of Texas                         Southwestern Medical Center at Dallas, Dallas, TX, USA, <email xlink:type="simple">elliot.frohman@utsouthwestern.edu</email>                     
               </aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Brannon</surname>
<given-names>K</given-names>
</name>
<aff>Department of Ophthalmology, University of Texas Southwestern Medical                         Center at Dallas, Dallas, TX, USA</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Alexander</surname>
<given-names>Sherry</given-names>
</name>
<aff>Department of Ophthalmology, University of Texas Southwestern Medical                         Center at Dallas, Dallas, TX, USA</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sims</surname>
<given-names>D</given-names>
</name>
<aff>Department of Radiology, University of Texas Southwestern Medical Center                         at Dallas, Dallas, TX, USA</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Phillips</surname>
<given-names>J T</given-names>
</name>
<aff>Baylor University Medical Center, Dallas, TX, USA</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>O'Leary</surname>
<given-names>S</given-names>
</name>
<aff>Baylor University Medical Center, Dallas, TX, USA</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hawker</surname>
<given-names>K</given-names>
</name>
<aff>Department of Ophthalmology, University of Texas Southwestern Medical                         Center at Dallas, Dallas, TX, USA</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Racke</surname>
<given-names>M K</given-names>
</name>
<aff>Department of Ophthalmology, University of Texas Southwestern Medical                         Center at Dallas, Dallas, TX, USA, the Center for Immunology, University of                         Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</aff>
</contrib>
</contrib-group>             
         <pub-date pub-type="ppub"><month>06</month>
<year>2004</year>
</pub-date>
<volume>10</volume>
<issue>3</issue>
<fpage>302</fpage>
<lpage>307</lpage>
<abstract>             
            <p>                 
               <bold>Background</bold>
: The objective for this article is to highlight some of the                 adverse skin manifestations associated with injectable disease modifying therapy for                 multiple sclerosis (MS). Early identification and intervention can often lead to                 minimal consequences and prolonged patient tolerance and compliance with these                 agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas                 Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority                 of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS                 (SPMS) are treated with one of the currently available disease modifying agents (DMA                 s). O ur experience with these patients, and the challenges they face in continuing                 long-term treatment, constitutes the basis of our proposed treatment strategies.                 <bold>Conclusion</bold>
: Skin reactio ns in response to injectable DMA therapy in MS are                 generally mild. However, some reactio ns can evolve into potentially serious lesions                 culminating in infection, necro sis, and in some circumstances requiring surgical repair.</p>         
         </abstract>
<kwd-group>             
            <kwd>abscess</kwd>             
            <kwd>erythema</kwd>             
            <kwd>glatiramer acetate</kwd>             
            <kwd>interferon beta</kwd>             
            <kwd>necrosis</kwd>         
         </kwd-group>
<custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name>
<meta-value>Journal Article</meta-value>
</custom-meta>
<custom-meta xlink:type="simple"><meta-name>search-text</meta-name>
<meta-value> Disease modifying agent related skin reactions in multiple sclerosis:             prevention, assessment, and management EM Frohman*,1,2 , K Brannon1 , Sherry Alexander1             , D Sims3 , JT Phillips5 , S O'Leary5 , K Hawker1 and MK Racke1,4 1 Department of             Neurology, 2 Department of Ophthalmology, 3 Department of Radiology, and 4 the Center             for Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX,             USA; 5 Baylor University Medical Center, Dallas, TX, USA Background: The objective for             this article is to highlight some of the adverse skin manifestations associated with             injectable disease modifying therapy for multiple sclerosis (MS). Early identification             and intervention can often lead to minimal consequences and prolonged patient tolerance             and compliance with these agents. At the University of Texas Southwestern Medical C             enter at Dallas and Texas Neurology in Dallas we actively follow approximately 5000 MS             patients. The majority of our patients with relapsing¡/remitting MS (RRMS) or secondary             progressive MS (SPMS) are treated with one of the currently available disease modifying             agents (DMAs). Our experience with these patients, and the challenges they face in             continuing long-term treatment, constitutes the basis of our proposed treatment             strategies. Conclusion: Skin reactions in response to injectable DMA therapy in MS are             generally mild. However, some reactions can evolve into potentially serious lesions             culminating in infection, necrosis, and in some circumstances requiring surgical repair.             Multiple Sclerosis (2004) 10, 302¡/307 Key words: abscess; erythema; glatiramer acetate;             interferon beta; necrosis Introductio n All of the primary disease modifying agents             (DMAs) for the treatment of multiple sclerosis (MS) require indefinite injection therapy             (Avonex® , Betaseron® , Rebif® , Copaxone® ), which can be associated with a variety of             adverse events. A patient's commitment and compliance with any of these therapies is             likely to be contingent upon understanding the available data confirming efficacy in MS,             as well as having realistic expectations about treat- ment objectives and the             recognition of potentially adverse side effects and their management.1 Ultimately, MS             patients can achieve maximum benefits from these agents if they are reasonably well             tolerated and used with consistency. Patients should be expertly instructed on the             process of drug preparation and in the execution of the injection technique. Many             patients may discontinue therapy because of poor training in these areas, particu- larly             when skin reactions become evident. Subcutaneous injection therapy (Betaseron® , Rebif®             , Copaxone® ) can result in a greater number of local adverse events com- pared with             intramuscular therapy (Avonex® ), including skin infection, pain, and occasionally             necrosis. The identification and management of these adverse events can be pivotal in             maintaining our patients on therapy. While most MS patients receive expert instruction             on the preparation and administration of injectable DMAs, it remains crucial to inquire             about any ongoing problems and to periodically review the injection technique. We             emphasize the necessity of scheduled follow-up visits with our nurses or physician             assistants (within the first few months after initiating therapy) in order to explore             all aspects of the treatment process. These visits provide for the opportunity to assess             compliance, provide enthusias- tic support and encouragement, reveal any areas of             difficulty, and further refine the treatment experience. Interferon related skin             reactions A number of practical techniques can be employed in order to minimize skin             related adverse events (Table 1). With respect to interferon treatment, the majority of             skin reactions are restricted to the subcutaneous administered forms (Betaseron® and             Rebif® ). However, intramuscular Avonex® injections can occasionally be associated with             mild bruising, an infrequent problem with this route of administration. Alternately, the             intramuscular route of administration can be difficult to execute for some patients.             Furthermore, some Avonex® -treated patients may experience significant pain as well as             transient *Correspondence: Elliot M Frohman, MD, PhD, Department of Neurology,             University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd.,             Dallas, Texas 75235, USA. E-mail: elliot.frohman@utsouthwestern.edu Received 3 September             2003; revised 31 October 2003; accepted 5 November 2003 Multiple Sclerosis 2004; 10:             302¡/307 www.multiplesclerosisjournal.com # Arnold 2004 10.1191/1352458504ms1002oa             bleeding following the injections. It is important to educate patients prior to             commencing therapy on the possibility of these occurrences. Patients and physicians must             also be aware of the fact that certain patients may not be appropriate for intramuscular             injection therapy, such as those on anticoagulation. Fortunately most skin reactions in             those treated with subcutaneous injection therapy are mild, consisting pri- marily of             erythematous site responses. In some cases patients can develop erythematous plaques,             ulcers, and granulomatous reactions.2,3 For unclear reasons, such reactions are             exceedingly more common in women (8:1).3 In those treated with subcutaneous IFNb1b (Be-             taseron® ), the development of skin necrosis occurs in about 5% of patients, whereas             injection site reactions occurred in about 80% of treated patient initially, and in 50%             by the end of year five of treatment.4¡ 7 Patients treated with the subcutaneous form of             IFNb1a (Rebif® ) developed injection site necrosis at a rate of once per 14 100             injections in the low-dose group (22 mg three times weekly) and once per 9300 injections             for those treated with high-dose IFN (44 mg three times weekly).8 In the extension phase             of this trial, 17 of the 27 patients that withdrew from the study did so because of             injection site reactions and 15 of the 17 were from the high-dose group.8 The             predisposing factors that result in these potentially serious complications are not             fully understood. Never- theless, poor injection technique, inadequate skin clean- ing,             too short a needle length, repeated use of the same injection site, and sun exposure             have been advanced as potential causes.9 An unconfirmed hypothesis has been that             microthrombosis and vasculitic mechanisms underlie these more serious reactions.2,10 We             have made the anecdotal observation that smokers tend to have a higher predilection for             adverse skin reactions. In those patients with necrosis or abscess formation, topical             steroids should be avoided, as these agents can delay the healing process. Psoriasis             vulgaris can be associated with IFN prepara- tions.11,12 We have observed both the new             onset as well as exacerbation of established psoriasis in a number of our IFN-treated             patients. In about 4% of IFNb treated patients, alopecia will develop and is typically             related to telogen effluvium.13,14 While not an evidenced-based recommen- dation, we             have found that vitamin E (400¡/800 units daily) along with selenium replacement can             either slow the rate of hair loss or restore growth in a number of our patients. While             quite rare, we have had two patients develop injection site intramuscular abscesses             while using Avonex® . These processes were characterizedby injection site discomfort,             swelling, and palpation tenderness. The diagnosis was confirmed by imaging studies and             both recovered following surgical incision and drainage. Case report A 46-year old man             with secondary progressive MS (SPMS) with relapses has been treated with weekly             intramuscular Avonex® since January 1998. He had no significant side effects or             complications until November 2001, when he began to note some swelling and tenderness in             the left anterior thigh at the site of a recent injection. There was no evidence of             cutaneous bruising or discoloration. He was afebrile but significantly fatigued. The             suspicion of an intramuscular abscess led to the performance of an MRI of his thigh. The             study revealed evidence of diffuse sub- cutaneous edema, myositis, and myonecrosis             (Figure 1). Surgical incision and drainage was successful in resolving this process             without further complication. The patient has continued Avonex® therapy for an             additional two years without recurrence of injection site reaction. Table 1 Preparation             and execution of DMA injections DMA injection procedures Practical pearls and pitfalls             Injection planning Allow medication to warm to room temperature Consider shorter needle             length in those with lean body mass Smoking cessation Injection mechanics Consider use             of autoinjector for subcutaneously administered medication Rotate injection sites             Consider use of site maps Site preparation Consider use of local anesthetics, such as             EMLA or aerosolized ethyl chloride Consider use of other topical analgesics, such as             gabapentin, lidocaine, clonidine Application of ice for 30¡/60 seconds before site             cleaning and injection Final procedures Wash hands thoroughly Thorough cleaning of             injection site Application of alcohol Allow alcohol to completely dry Avoid having any             medication on needle tip Ensure complete penetration of needle into injection site             Topical steroids (1¡/2% hydrocortisone) for post-injection erythema Avoid topical             steroids at sites of infection or apparent abscess or necrosis Consider imaging in             suspected abscess Skin reactions in MS EM Frohman et al. 303 Multiple Sclerosis Figure 1             MRI of the left lower extremity reveals abnormal signal within the muscle of the             anterior compartment of the quadriceps. There is diffuse myositis and frank uid             collection in the vastus intermedius muscle consistent with myonecrosis (abscess). There             is also subcutaneous edema circumferentially in the left leg that is nonspeci c but             could be due to cellulites or lymphedema. Length is measured as 19.5 cm long             (cranial-caudal) on the T1 post contrast longitudinal sagittal plane lms (A). Transverse             width is 8.4 cm maximally and AP width is 4.5 cm maximally (B). A surrounding rim of             gadolinium enhancement de nes the perimeter of the abscess (arrows). Skin reactions in             MS EM Frohman et al. 304 Multiple Sclerosis C opaxone® related skin reactions Site             reactions are also common in patients treated with Copaxone® and generally involve local             erythema. In the phase III prospective randomized controlled study of Copaxone® in             relapsing¡/remitting MS (RRMS), erythema and induration was seen in about 90% of treated             patients.15 Copaxone® -treated patients may also develop palpable, occasionally painful,             lumps beneath the injec- tion sites that are generally short-lived, although they may             persist in some individuals.15 Alternately, some Copaxone® -treated patients will             develop lipoatrophy over time, characterized by irregular areas of skin depres- sion.16             While quite rare, we have also identified a number of patients with adenopathy,             pruritus, rash, and urticaria following the onset of Copaxone® treatment. With increased             duration of therapy, many DMA-related adverse events tend to decrease in frequency;             however, skin reactions do tend to persist.6 Here we report an unusual adverse skin             reaction in a man with excellent injection technique and compliance that occurred after             five years of Copaxone® treatment without complications. Case report A 42-year old man             with RRMS has been treated with daily glatiramer acetate (Copaxone® ) since July 1997.             The patient has been highly compliant and without any difficulties with the injection             technique. The course of his MS remarkably stabilized and he has been without             exacerbation or any evidence of disease progression. In November 2002 he developed an             area of erythema on the left lateral thigh at the injection site, similar to the             reactions that he has previously experienced. However, this initially circumscribed area             of irritation disseminated in a centrifugal fashion and was associated with signifi-             cant pain. Ultimately the lesion achieved a size of approximately two inches by 1.5             inches (Figure 2) and a large eschar developed. He visited his primary care physician             who began therapy with local antibiotics. Upon further history, the patient revealed             that previous injections (only on the left leg) had been associated with localized areas             of erythema and a small subcutaneous blister, followed by a stereotypic pattern of             resolution. This report emphasized the important observation that significant skin             reactions can occur with glatiramer acetate therapy. Furthermore, we have not             infrequently heard patients report that particular injection sites appear to have a             higher predilection for being associated with adverse reactions. Finally, while the risk             of skin necrosis and abscess is more commonly associated with interferon therapy in MS             patients, we must be vigilant in assessing patients that develop unusual injection site             reactions to glatiramer acetate as well. Practical aspects of skin management Over the             years, we have utilized a number of techniques in order to minimize the incidence of             skin reactions in MS patients being treated with injection therapy (Table 1). Patients             must be educated on the importance of thorough skin cleaning techniques. Irrespective of             the route of administration, injection therapy is painful. Conse- quently, patients must             be prepared to have reasonable expectations on the likelihood of pain and its potential             mitigation with certain techniques. It is encouraging to note that the vast majority of             patients will tolerate the injection technique. However, in some patients, the pain may             be substantial and thereby preclude long-term com- pliance with the prescribed regimen.             For these patients, painful skin reactions can be significantly reduced with the             application of ice immediately before cleaning the skin surface in preparation for             injection. We generally suggest holding an ice cube at the chosen site for 30¡/60             seconds followed by rapid cleaning and injection. Other patients find the use of topical             anesthetics, such as lidocaine or compounded topical gabapentin cream (per- sonal             observation), to be highly effective in diminishing injection site pain. Skin irritation             and erythema as well as pain may also be minimized by the use of topical steroids. As a             practical measure, we suggest that patients ensure that the needle has completely             penetrated the skin surface in order to avoid epidermal or dermal infusion of the drug,             which may incite a more substantial skin reaction. Also, it is advisable to avoid             discharging liquid medication onto the needle prior to injection. Allowing the mixed             medica- tions to reach room temperature may also reduce injec- tion-related             discomfort.15 In patients with a lean body mass who are being treated with intramuscular             Avonex® , we suggest the use of 1-inch needles. In carefully selected patients, we find             this needle size to be better tolerated than the traditional 1.25- or 1.5- inch needles.             Furthermore, we have found that a smaller gauge of needle can be utilized (e.g., 25             gauge) with better patient tolerability. For subcutaneous drug administrations             (Betaseron® , Rebif® , and Copaxone® ), autoinjectors are now available, which may             enhance compliance and reduce the intensity and frequency of skin reactions.             Nevertheless, we have found that autoinjectors are not preferred by all patients, as             some have become quite expert in the manual injection technique. Prefilled products also             allow for greater convenience, particularly in those MS patients that have difficulty             with hand dexterity and need to self administer their medica- tion. These products are             of lower pH, which facilitates greater stability at room temperature which also improves             convenience. Nevertheless, the lower pH can result in greater pain during the injection             process. We have had numerous patients describe this experience with injection of Rebif®             . Most recently, Avonex® has become available as a prefilled, albumin-free product.             While this formulation should be substantially more convenient for our patients, the             shorter duration of drug stability (around 12 hours at room temperature) will present a             limitation for some, particularly those that travel frequently. Skin reactions in MS EM             Frohman et al. 305 Multiple Sclerosis Rotation of injection sites constitutes another             important factor in the tolerability and safety of injection therapy. Interestingly,             there often appears a predilection for ad- verse skin events to occur at certain sites,             and less so at others. We emphasize the importance of avoiding serial injections at the             same site as this may increase the risk of infection and more severe site reactions.             Some patients may benefit from keeping a 'site map' in order to remind them of             previously used injection sites. C onclusions Disease modifying injectable therapy for             MS can be associated with a variety of adverse skin manifestations. These reactions are             more commonly observed with sub- cutaneous administered preparations. Providers and pa-             tients must be aware of these potential complications and their management. Figure 2             Photograph of a necrotic skin lesion secondary to glatiramer acetate subcutaneous             injection (A). In (B) a prior injection site reaction is demarcated that did not result             in a necrotic skin lesion. For unclear reasons these site reactions were restricted to             the left thigh. Skin reactions in MS EM Frohman et al. 306 Multiple Sclerosis References             1 Frohman EM, Phillips JT, Kokel K, Van Pelt JD, O'Leary S, Gross S, Hawker K, Racke MK.             Disease management strategies for multiple scleosis: managing adverse events and             optimizing compliance. Neurologist 2002; 8: 227¡/36. 2 Elgart GW, Sheremata W, Ahn YS.             Cutaneous reactions to recombinant human interferon beta-1b: the clinical and histologic             spectrum. J Am Acad Dermatol 1997; 37: 553¡/58. 3 Mehta CL, Tyler RJ, Cripps DJ.             Granulomatous dermatitis with focal sarcoidal features associated with recombinant             inter- feron b1b injections. J Am Acad Dermatol 1998; 39: 1024¡/28. 4 Gaines AR,             Varricchio F. Interferon beta-1b injection site reactions and necroses. Mult Scler 1998;             4: 70¡/73. 5 The IFNb Multiple Sclerosis Study Group. Interferon beta-1b is effective in             relapsing¡/remitting multiple sclerosis. I. Clin- ical results of a multicenter,             randomized, double-blind, placebo-controlled trial. Neurology 1993; 43: 655¡/61. 6 The             IFNb Multiple Sclerosis Study Group and the UBC MS/ MRI Analysis Group. Interferon             beta-1b in the treatment of multiple sclerosis: nal outcome of the randomized controlled             trial. Neurology 1995; 45: 1277¡/85. 7 European Study Group on Interferon b-1b in             Secondary Progressive MS. Placebo-controlled multicentre randomized trial of interferon             b-1b in treatment of secondary progressive multiple sclerosis. Lancet 1998; 352:             1491¡/97. 8 PRISMS Study Group. PRISMS-4: long term ef cacy of interferon-b1a in             relapsing MS. Neurology 2001; 56: 1628¡/36. 9 Knobler RL, Kelley CL, Trantas F, Webster             GF, Lublin FD. Interferon beta-1b induced ulcerative skin lesions in MS. J Neuroimmunol             1994; 54: 173 (Abstract). 10 Weinberg JM, Wolfe JT, Sood S, Saruk M, Rook AH, Spiers EM.             Cutaneous necrosis associated with recombinant interferon injection. Report of three             cases with interferon beta-1b and review of the literature. Acta Derm Venerol (Stockh)             1997; 77: 146¡/48. 11 Quesada JR, Gutterman JU. Psoriasis and interferon alpha. Lancet             1986; 1: 1466¡/68. 12 Webster GF, Knobler RL, Lublin FD, Kramer EM, Hochman LR.             Cutaneous ulcerations and pustular psoriasis are caused by recombinant interferon beta             injections in patients with multi- ple sclerosis. J Am Acad Dermatol 1996; 34: 365¡/67.             13 Betaseron® (interferon beta-1b), prescribing information. Richmond, CA: Berlex             Laboratories, July 1993. 14 Avonex® (interferon beta-1a), prescribing information. Cam-             bridge, MA: Biogen Inc., May 1996. 15 Drago F, Grusati C, Mancardi G, Murialdo A, Rebora             A. Localized lipoatrophy after glatiramer acetate injection in patients with             remitting¡/relapsing multiple sclerosis. Arch Dermatol 1999; 135: 1277¡/78. 16 Albani C,             Albani G. A case of cutaneous necrosis during interferon-b1b (B-IFN) therapy in multiple             sclerosis. J Neurol Neurosurg Psychiatry 1997; 62: 418. Skin reactions in MS EM Frohman             et al. 307 Multiple Sclerosis</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<back><ref-list>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Frohman EM</surname>
</name>
                 ,                      <name name-style="western"><surname>Phillips JT</surname>
</name>
                 ,                      <name name-style="western"><surname>Kokel K</surname>
</name>
                 ,                      <name name-style="western"><surname>Van Pelt JD</surname>
</name>
                 ,                      <name name-style="western"><surname>O’Leary S</surname>
</name>
                 ,                      <name name-style="western"><surname>Gross S</surname>
</name>
                 ,                      <name name-style="western"><surname>Hawker K</surname>
</name>
                 ,                      <name name-style="western"><surname>Racke MK.</surname>
</name>                                                       
               <article-title>Disease management strategies for multiple scleosis: managing adverse                         events and optimizing compliance</article-title>
                 . <source>Neurologist</source>                 
               <year>2002</year>
; <volume>8</volume>
:                      <fpage>227</fpage>
-<lpage>236</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Elgart GW</surname>
</name>
                 ,                      <name name-style="western"><surname>Sheremata W</surname>
</name>
                 ,                      <name name-style="western"><surname>Ahn YS.</surname>
</name>                                                       
               <article-title>Cutaneous reactions to recombinant human interferon beta-1b: the clinical                         and histologic spectrum</article-title>
                 . <source>J Am Acad Dermatol</source>                 
               <year>1997</year>
; <volume>37</volume>
:                      <fpage>553</fpage>
-<lpage>558</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Mehta CL</surname>
</name>
                 ,                      <name name-style="western"><surname>Tyler RJ</surname>
</name>
                 ,                      <name name-style="western"><surname>Cripps DJ.</surname>
</name>                                                       
               <article-title>Granulomatous dermatitis with focal sarcoidal features associated with                         recombinant inter-feron b1b injections</article-title>
                 . <source>J Am Acad Dermatol</source>                 
               <year>1998</year>
; <volume>39</volume>
:                      <fpage>1024</fpage>
-<lpage>1028</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Gaines AR</surname>
</name>
                 ,                      <name name-style="western"><surname>Varricchio F.</surname>
</name>                                                       
               <article-title>Interferon beta-1b injection site reactions and necroses</article-title>
                 . <source>Mult Scler</source>                 
               <year>1998</year>
; <volume>4</volume>
:                      <fpage>70</fpage>
-<lpage>73</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>The IFNb Multiple Sclerosis Study Group</surname>
</name>
                 .                      <article-title>Interferon beta-1b is effective in relapsing-remitting multiple sclerosis.                         I. Clinical results of a multicenter, randomized, double-blind,                         placebo-controlled trial</article-title>
                 . <source>Neurology</source>                 
               <year>1993</year>
; <volume>43</volume>
:                      <fpage>655</fpage>
-<lpage>661</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>The IFNb Multiple Sclerosis Study Group</surname>
</name>
                  and the                      <name name-style="western"><surname>UBC MS/MRI Analysis Group</surname>
</name>
                 .                      <article-title>Interferon beta-1b in the treatment of multiple sclerosis: final outcome of                         the randomized controlled trial</article-title>
                 . <source>Neurology</source>                 
               <year>1995</year>
; <volume>45</volume>
:                      <fpage>1277</fpage>
-<lpage>1285</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>European Study Group on Interferon b-1b in Secondary Progressive MS.</surname>
</name>                                                       
               <article-title>Placebo-controlled multicentre randomized trial of interferon b-1b in                         treatment of secondary progressive multiple sclerosis</article-title>
                 . <source>Lancet</source>                 
               <year>1998</year>
; <volume>352</volume>
:                      <fpage>1491</fpage>
-<lpage>1497</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>PRISMS Study Group</surname>
</name>
                 .                      <article-title>PRISMS-4: long term efficacy of interferon-b1a in relapsing MS</article-title>
                 . <source>Neurology</source>                 
               <year>2001</year>
; <volume>56</volume>
:                      <fpage>1628</fpage>
-<lpage>1636</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Knobler RL</surname>
</name>
                 ,                      <name name-style="western"><surname>Kelley CL</surname>
</name>
                 ,                      <name name-style="western"><surname>Trantas F</surname>
</name>
                 ,                      <name name-style="western"><surname>Webster GF</surname>
</name>
                 ,                      <name name-style="western"><surname>Lublin FD.</surname>
</name>                                                       
               <article-title>Interferon beta-1b induced ulcerative skin lesions in MS</article-title>
                 . <source>J Neuroimmunol</source>                 
               <year>1994</year>
; <volume>54</volume>
:                      <fpage>173</fpage>
-<lpage>173</lpage>
                  (Abstract).</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Weinberg JM</surname>
</name>
                 ,                      <name name-style="western"><surname>Wolfe JT</surname>
</name>
                 ,                      <name name-style="western"><surname>Sood S</surname>
</name>
                 ,                      <name name-style="western"><surname>Saruk M</surname>
</name>
                 ,                      <name name-style="western"><surname>Rook AH</surname>
</name>
                 ,                      <name name-style="western"><surname>Spiers EM.</surname>
</name>                                                       
               <article-title>Cutaneous necrosis associated with recombinant interferon injection. Report                         of three cases with interferon beta-1b and review of the literature</article-title>
                 . <source>Acta Derm Venerol (Stockh)</source>                 
               <year>1997</year>
; <volume>77</volume>
:                      <fpage>146</fpage>
-<lpage>148</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Quesada JR</surname>
</name>
                 ,                      <name name-style="western"><surname>Gutterman JU.</surname>
</name>                                                       
               <article-title>Psoriasis and interferon alpha</article-title>
                 . <source>Lancet</source>                 
               <year>1986</year>
; <volume>1</volume>
:                      <fpage>1466</fpage>
-<lpage>1468</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Webster GF</surname>
</name>
                 ,                      <name name-style="western"><surname>Knobler RL</surname>
</name>
                 ,                      <name name-style="western"><surname>Lublin FD</surname>
</name>
                 ,                      <name name-style="western"><surname>Kramer EM</surname>
</name>
                 ,                      <name name-style="western"><surname>Hochman LR.</surname>
</name>                                                       
               <article-title>Cutaneous ulcerations and pustular psoriasis flare caused by recombinant                         interferon beta injections in patients with multiple sclerosis</article-title>
                 . <source>J Am Acad Dermatol</source>                 
               <year>1996</year>
; <volume>34</volume>
:                      <fpage>365</fpage>
-<lpage>367</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="book" xlink:type="simple">                                      
               <name name-style="western"><surname>Betaseron®</surname>
</name>                                  
               <source>(interferon beta-1b), prescribing information</source>
.                      <publisher-loc>Richmond, CA</publisher-loc>
: <publisher-name>Berlex Laboratories</publisher-name>
                 , July <year>1993</year>
.</citation>         
         </ref>         
         <ref>             
            <citation citation-type="book" xlink:type="simple">                                      
               <name name-style="western"><surname>Avonex®</surname>
</name>                                  
               <source>(interferon beta-1a), prescribing information</source>
.                      <publisher-loc>Cambridge, MA</publisher-loc>
: <publisher-name>Biogen Inc.</publisher-name>
                 , May <year>1996</year>
.</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Drago F</surname>
</name>
                 ,                      <name name-style="western"><surname>Grusati C</surname>
</name>
                 ,                      <name name-style="western"><surname>Mancardi G</surname>
</name>
                 ,                      <name name-style="western"><surname>Murialdo A</surname>
</name>
                 ,                      <name name-style="western"><surname>Rebora A.</surname>
</name>                                                       
               <article-title>Localized lipoatrophy after glatiramer acetate injection in patients with                         remitting-relapsing multiple sclerosis</article-title>
                 . <source>Arch Dermatol</source>                 
               <year>1999</year>
; <volume>135</volume>
:                      <fpage>1277</fpage>
-<lpage>1278</lpage>
                 .</citation>         
         </ref>         
         <ref>             
            <citation citation-type="journal" xlink:type="simple">                                      
               <name name-style="western"><surname>Albani C</surname>
</name>
                 ,                      <name name-style="western"><surname>Albani G.</surname>
</name>                                                       
               <article-title>A case of cutaneous necrosis during interferon-b1b (B-IFN) therapy in                         multiple sclerosis</article-title>
                 . <source>J Neurol Neurosurg Psychiatry</source>                 
               <year>1997</year>
; <volume>62</volume>
:                      <fpage>418</fpage>
-<lpage>418</lpage>
                 .</citation>         
         </ref>     
      </ref-list>
</back>
</article>
</istex:document>
</istex:metadataXml>
<mods version="3.6"><titleInfo lang="en"><title>Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
</titleInfo>
<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management</title>
</titleInfo>
<name type="personal"><namePart type="given">E M</namePart>
<namePart type="family">Frohman</namePart>
<affiliation>Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA,</affiliation>
<affiliation>E-mail: elliot.frohman@utsouthwestern.edu</affiliation>
</name>
<name type="personal"><namePart type="given">K</namePart>
<namePart type="family">Brannon</namePart>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</name>
<name type="personal"><namePart type="given">Sherry</namePart>
<namePart type="family">Alexander</namePart>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</name>
<name type="personal"><namePart type="given">D</namePart>
<namePart type="family">Sims</namePart>
<affiliation>Department of Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</name>
<name type="personal"><namePart type="given">J T</namePart>
<namePart type="family">Phillips</namePart>
<affiliation>Baylor University Medical Center, Dallas, TX, USA</affiliation>
</name>
<name type="personal"><namePart type="given">S</namePart>
<namePart type="family">O'Leary</namePart>
<affiliation>Baylor University Medical Center, Dallas, TX, USA</affiliation>
</name>
<name type="personal"><namePart type="given">K</namePart>
<namePart type="family">Hawker</namePart>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</name>
<name type="personal"><namePart type="given">M K</namePart>
<namePart type="family">Racke</namePart>
<affiliation>Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, the Center for Immunology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA</affiliation>
</name>
<typeOfResource>text</typeOfResource>
<genre type="research-article" displayLabel="research-article"></genre>
<originInfo><publisher>Sage Publications</publisher>
<place><placeTerm type="text">Sage CA: Thousand Oaks, CA</placeTerm>
</place>
<dateIssued encoding="w3cdtf">2004-06</dateIssued>
<copyrightDate encoding="w3cdtf">2004</copyrightDate>
</originInfo>
<language><languageTerm type="code" authority="iso639-2b">eng</languageTerm>
<languageTerm type="code" authority="rfc3066">en</languageTerm>
</language>
<physicalDescription><internetMediaType>text/html</internetMediaType>
</physicalDescription>
<abstract lang="en">Background: The objective for this article is to highlight some of the adverse skin manifestations associated with injectable disease modifying therapy for multiple sclerosis (MS). Early identification and intervention can often lead to minimal consequences and prolonged patient tolerance and compliance with these agents. A t the University of Texas Southwestern Medical C enter at Dallas and Texas Neurology in Dallas we actively follow appro ximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available disease modifying agents (DMA s). O ur experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. Conclusion: Skin reactio ns in response to injectable DMA therapy in MS are generally mild. However, some reactio ns can evolve into potentially serious lesions culminating in infection, necro sis, and in some circumstances requiring surgical repair.</abstract>
<subject><genre>keywords</genre>
<topic>abscess</topic>
<topic>erythema</topic>
<topic>glatiramer acetate</topic>
<topic>interferon beta</topic>
<topic>necrosis</topic>
</subject>
<relatedItem type="host"><titleInfo><title>Multiple Sclerosis</title>
</titleInfo>
<genre type="journal">journal</genre>
<identifier type="ISSN">1352-4585</identifier>
<identifier type="eISSN">1477-0970</identifier>
<identifier type="PublisherID">MSJ</identifier>
<identifier type="PublisherID-hwp">spmsj</identifier>
<part><date>2004</date>
<detail type="volume"><caption>vol.</caption>
<number>10</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>3</number>
</detail>
<extent unit="pages"><start>302</start>
<end>307</end>
</extent>
</part>
</relatedItem>
<identifier type="istex">239CC14D65231835D5D426C8C23A0A116CE30470</identifier>
<identifier type="DOI">10.1191/1352458504ms1002oa</identifier>
<identifier type="ArticleID">10.1191_1352458504ms1002oa</identifier>
<recordInfo><recordContentSource>SAGE</recordContentSource>
</recordInfo>
</mods>
</metadata>
<serie></serie>
</istex>
</record>

Pour manipuler ce document sous Unix (Dilib)

EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Istex/Corpus

HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001045 | SxmlIndent | more

HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 001045 | SxmlIndent | more

Pour mettre un lien sur cette page dans le réseau Wicri

{{Explor lien
   |wiki=    Wicri/Sante
   |area=    LymphedemaV1
   |flux=    Istex
   |étape=   Corpus
   |type=    RBID
   |clé=     ISTEX:239CC14D65231835D5D426C8C23A0A116CE30470
   |texte=   Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management
}}

This area was generated with Dilib version V0.6.31.
Data generation: Sat Nov 4 17:40:35 2017. Site generation: Tue Feb 13 16:42:16 2024

	Serveur d'exploration sur le lymphœdème
	Attention, ce site est en cours de développement ! Attention, site généré par des moyens informatiques à partir de corpus bruts. Les informations ne sont donc pas validées.

Serveur d'exploration sur le lymphœdème

Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management

Disease modifying agent related skin reactions in multiple sclerosis: prevention, assessment, and management

Source :

Abstract

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri