Monitoring the skin on fingolimod

# MS Research #Clinicspeak

Samaraweera AP, Cohen SN, Akay EM, Evangelou N. Lymphomatoid papulosis: A cutaneous lymphoproliferative disorder in a patient on fingolimod formultiple sclerosis. Mult Scler. 2015 . pii: 1352458515597568. [Epub ahead of print]

BACKGROUND: Fingolimod was the first oral disease-modifying treatment for relapsing-remitting multiple sclerosis. It has previously been associated with the development of lymphoma.
OBJECTIVE: To describe a case of lymphomatoid papulosis, a CD30+ cutaneous lymphoproliferative disorder, in a patient taking fingolimod.
RESULTS: Our patient developed lymphomatoid papulosis 2 months after starting fingolimod. Histology confirmed the diagnosis. The drug was withdrawn. Resolution began only 2 days later.
CONCLUSIONS: Lymphomatoid papulosis is a benign subtype of cutaneous T-cell lymphoma, but up to 20% of cases can transform to a malignant course. Patients on fingolimod and physicians caring for them should be mindful of the need to monitor the skin.

Lymphomatoid papulosis (LyP) is a rare skin disorder and is a disease of the immune system that manifests itself in self-healing papules and nodules (“bumps” and “spots”) that come and go spontaneously. LyP can be persistent with recurrent eruptions or it can disappear for weeks or months at a time before reactivating.

LyP is a one in a million disease – the overall incidence rate is estimated at only 1.2 to 1.9 casesper 1,000,000 population. The onset of LyP can happen anytime from early childhood to middle
age, it affects both sexes equally however it appears to affect Caucasian individuals more frequently.

LyP is characterized by red-brown bumps and spots, that may ulcerate and typically heal withscaling and crusting, and in some instances, scarring. Large plaques or nodules may occur but
these are rare. Lesions usually heal over 2-3 weeks but may take as long as 8 weeks. The number of lesions can vary from each eruption and can vary in size and severity with each onset. Lesions
may be asymptomatic or can be itchy or painful.

LyP is not contagious.and in up to 90% of cases, LyP is a persistent or self-limited disease with no associations with other immune system diseases and does not affect the overall health of the patient. In up to 10% of LyP cases, there is an association with lymphomas may develop before, after or at the same time the lymphoma is diagnosed.

If you develop such signs contact your MS Nurse/Neurologist

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