Skin injection site reactions with injectable DMT

If you inject DMDs, this one you know about.


Injectable medications and needles in general are unpleasant. For people who do have a phobia of needles, the routine injection of the DMDs is associated with a negative experience. Can you imagine if you had to inject four times every day like most people with insulin dependent diabetes? Well, it seems their injections are not as unpleasant as MS DMD injections. Rarely injection site reactions can be severe with necrosis (death of the skin) causing an ulcer; occasionally, there is lipoatrophy (loss of fatty tissue; photo); frequently inflamed sometimes pruritic (itchy) reaction to the injections are the most common local reactions and how bad they are and how long they last depend not only on the drug but also on the skin they are injected on. Dry scaly skin will probably be more prone to itchy lesions. The tricks that your MS nurse can teach you are useful: hot/cold packs, plenty of hypoallergic (no scent, less allergens; not to be confounded with eco-friendly) moisturising creams and rotation of injection sites.




DMW Balak et al. Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: a systematic review Mult Scler doi:10.1177/1352458512438239 [Epub ahead of print)


Glatiramer acetate and interferon-beta are approved first-line disease-modifying treatments (DMTs) for MS. DMTs can be associated with cutaneous adverse events skin reactions), which may influence treatment adherence and patient quality of life.


In this systematic review, the authors' 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 MS'ers 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'ers 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.

In the USA the FDA has just approved an “auto-injector” device for delivering a dose of Avonex. Because the auto-injectors needle is thinner and shorter than that of a syringe, the hope is that the auto-injector will make things easier.

CoI: None

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