Cutaneous necrosis associated with recombinant interferon injection. Report of three cases with interferon beta-1b and review of the literature

Cutaneous Adverse Effects of Neurologic Medications

Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.

Multiple cutaneous necrotic lesions associated with Interferon beta-1b injection for multiple sclerosis treatment: A case report and literature review

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.