Authors
1 Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Students' Research Committee, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
3 Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Students’ Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
4 Pharmacy Students’ Research Committee, School of Pharmacy, Isfahan University of Medical sciences, Isfahan, Iran
Abstract
Multiple sclerosis (MS) is a chronic and debilitating inflammatory autoimmune disorder of the
central nervous system. MS patients may experience severe local inflammatory skin reactions
during disease-modifying therapy with subcutaneously injected interferon-beta-1b (IFN-β).
We report the case of a 49-year-old woman with relapsing-remitting MS, who developed
multiple cutaneous necrotic ulcers on both arms and thighs after 3 months of treatment with
subcutaneous IFN-β-1b. The biopsy specimens showed skin and subcutaneous tissue necrosis.
We diagnosed the skin lesions as cutaneous necrotic ulcerations associated with IFN-β-1b
injection. The treatment included ending the use of subcutaneously injected IFN-β-1b and
switching to intramuscularly injected IFN-β-1a because of the multiple cutaneous necrotic
ulcers. The injection of IFN-β-1b in the areas with lesions was stopped, and the patient’s
clinical condition improved with the addition of routine wound care, surgical debridement,
and skin grafting. This report is intended to raise awareness about severe adverse skin
reactions which may rarely occur with subcutaneous IFN-β-1b injection. Early recognition
and correction of the injection technique and switching to other forms of interferon can
help to prevent these complications.
Keywords
Meletiche DM. Comparing the cost‑effectiveness of
disease‑modifying drugs for the first‑line treatment of
relapsing‑remitting multiple sclerosis. J Manag Care Pharm
2009;15:543‑55.
2. Walther EU, Hohlfeld R. Multiple sclerosis: Side effects of
interferon beta therapy and their management. Neurology
1999;53:1622‑7.
3. Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S.
Adverse cutaneous drug reactions: Eight year assessment in
hospitalized patients. J Res Med Sci 2014;19:720‑5.
4. Elgart GW, Sheremata W, Ahn YS. Cutaneous reactions to
recombinant human interferon beta‑1b: The clinical and
histologic spectrum. J Am Acad Dermatol 1997;37:553‑8.
5. Fragoso YD, Paggiaro MS, Mastromauro R, Jacondino
Gda S, Wilson HM. Literature systematic review on the
ophthalmological side effects of interferons. Arq Bras Oftalmol
2011;74:306‑10.
6. Munschauer FE 3rd, Kinkel RP. Managing side effects of
interferon‑beta in patients with relapsing‑remitting multiple
sclerosis. Clin Ther 1997;19:883‑93.
7. Bayas A, Rieckmann P. Managing the adverse effects of
interferon‑beta therapy in multiple sclerosis. Drug Saf
2000;22:149‑59.
8. Gaines AR, Varricchio F. Interferon beta‑1b injection site
reactions and necroses. Mult Scler 1998;4:70‑3.
9. Yang CH, Chen CH, Chan HL. Skin necrosis following a
recombinant interferon‑beta‑1b injection. Chang Gung Med
J 2002;25:774‑7.
10. Buttmann M, Goebeler M, Toksoy A, Schmid S, Graf W,
Berberich‑Siebelt F, et al. Subcutaneous interferon‑beta injections in patients with multiple sclerosis initiate
inflammatory skin reactions by local chemokine induction.
J Neuroimmunol 2005;168:175‑82.
11. Sheremata WA, Taylor JR, Elgart GW. Severe necrotizing
cutaneous lesions complicating treatment with interferon
beta‑1b. N Engl J Med 1995;332:1584.
12. Feldmann R, Löw‑Weiser H, Duschet P, Gschnait F.
Necrotizing cutaneous lesions caused by interferon beta
injections in a patient with multiple sclerosis. Dermatology
1997;195:52‑3.
13. 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 Venereol
1997;77:146‑8.
14. Albani C, Albani G. A case of cutaneous necrosis during
interferon‑beta 1b (B‑IFN) therapy in multiple sclerosis.
J Neurol Neurosurg Psychiatry 1997;62:418.
15. García‑F‑Villalta M, Daudén E, Sánchez J, Fraga J, Ramo C,
García‑Díez A. Local reactions associated with subcutaneous
injections of both beta‑interferon 1a and 1b. Acta Derm
Venereol 2001;81:152.
16. Casoni F, Merelli E, Bedin R, Martella A, Cesinaro A,
BertolottoA. Necrotizing skin lesions and NABs development
in a multiple sclerosis patient treated with IFNbeta 1b. Mult
Scler 2003;9:420‑3.
17. Nakamura Y, Kawachi Y, Furuta J, Otsuka F. Severe local skin
reactions to interferon beta‑1b in multiple sclerosis‑improvement
by deep subcutaneous injection. Eur J Dermatol 2008;18:579‑82.