Wednesday, 2 August 2017

#ClinicSpeak: altered skin pigmentation after pegylated interferon

Are you on an injectable? Do you have altered skin pigmentation? #ClinicSpeak #MSBlog

The following case report of altered skin pigmentation in response to pegylated interferon-beta-1a (Plegridy) is interesting. The is a potential mechanism in that interferon increases the expression of a receptor, called alpha-melanocyte-stimulating hormone (MSH), on the surface of cells. As PEG-IFN-beta has such a long plasma half-life it may even increase incidence for such cutaneous side effects particularly in dark-skinned patients. However, this mechanism does not explain why this person has depigmentation in the legs. 

If you are a pwMS on interferon and have a similar problem we would be interested in hearing from you. You can email us  at bartsmsblog@gmail.com and it would be great if you can send us some pictures as well. Thank you. 

Coghe et al. Localized pigmentation disorder after subcutaneous pegylated interferon beta-1a injection. Mult Scler. 2017 Jul 1:1352458517708465.

We report the case of a 42-year-old female patient who developed peculiar skin lesions due to subcutaneous polyethylene glycol (PEG) interferon beta-1a. The dermatological examination showed hypochromic macules that had coalesced into a 10-cm-diameter patch. On the abdomen injection sites, there was a greyish diffuse hyperpigmentation arranged irregularly in annular macules. Fungal infection, vitiligo and pityriasis alba were excluded. After 6 months, the lesions had worsened. This is the first case of localized pigmentation disorder reported with interferon beta, and while the clinical findings are not ascribable to vitiligo or interferon-related facial/mucosal hyperpigmentation, they may partially share the underlying mechanisms. 


Figure from the MSJ.


Hyperpigmentation has been associated with use of pegylated interferon alpha suggesting a common mechanism. 

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