Commentary Open Access
Volume 1 | Issue 4 | DOI: https://doi.org/10.33696/Neurol.1.024

Cutaneous Side Effects of First-Second Line Oral Disease - Modifying Treatments in Patients with Multiple Sclerosis

  • 1Department of Neurology, School of Medicine, University of Hacettepe, Ankara, Turkey
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Corresponding Author

Doruk Arslan, dorukarslan@hacettepe.edu.tr

Received Date: June 06, 2020

Accepted Date: December 03, 2020


Multiple sclerosis (MS) is a progressive autoimmune and sometimes disabling disease of the central nervous system (CNS), characterized by formation of white matter lesions in the CNS due to inflammation, demyelination and axonal loss. Disease-modifying treatments (DMTs) are being investigated as a treatment choice in patients with MS. Teriflunomide, fingolimod and dimethyl fumarate are the most popular oral forms of the DMTs that are used usually for relapsing forms of MS (RMS), the most common disease phenotype. In this complementary, we have compiled the reports about cutaneous adverse reactions associated with oral first or second line DMTs. There have been recently published rare cases to point out serious cutaneous adverse effects associated with fingolimod therapy such as Kaposi sarcoma, peripheral vascular adverse effects, ecchymotic angioedema-like cutaneous lesions, lymphomatoid papulosis. There are also a few case reports about cutaneous adverse effects of teriflunomide, such as eczema, rash and palmar pustular psoriasis. In addition, a recently published case report has demonstrated another serious adverse effect associated with teriflunomide; drug – induced bullous pemphigoid. However, there aren’t many reported skin changes associated with dimethyl fumarate use in patients with MS, just a newly reported case report about transient hair loss. By examining the specific clinical, pharmacological and safety features of all drugs, we tried to provide an overview. In addition, it is important to point out some immunosuppressants may trigger autoimmune diseases. These DMTs may also have led to similar autoimmune phenomenon, attending to the development of some cutaneous autoimmune reactions. The molecular mechanisms behind these reactions are still unknown and further studies are needed to reveal them.


Multiple Sclerosis, Teriflunomide, Fingolimod, Dimethyl fumarate, Cutaneous adverse effects

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