Best Practices in Skin Care for the Multiple Sclerosis Patient Receiving Injectable Therapies

Abstract

Although a cure for multiple sclerosis (MS) has not yet been discovered, a number of treatment options are available to help control symptoms, slow disease progression, and improve quality of life in patients with relapsing-remitting MS (RRMS). These include disease-modifying therapies (DMTs) such as beta-interferons, glatiramer acetate, and natalizumab. Disease-modifying therapies requiring frequent, self-administered injections can be particularly troublesome for some patients, as they may result in localized skin reactions at the injection site. A variety of injection-site reactions (ISRs) have been reported, including pain and erythema, lipoatrophy, abscesses and infections, necrosis, rash, swelling, and lumps. In order to appropriately distinguish between normal and abnormal reactions and to determine when further intervention is required, nurses involved in the care of patients with MS should be knowledgeable about the potential ISRs associated with DMTs. This best practices document was developed by a panel of Canadian MS clinic nurses in order to increase recognition among nurses that MS patients are at high risk for skin-site reactions with injectable therapies, and to provide the basis for skin-care practices in these patients. It reviews the risk factors associated with adverse skin reactions in MS patients treated with injectable therapies; the current attitudes and beliefs of nurses with respect to skin care; and the optimal skin-care interventions for MS patients at risk for adverse skin reactions when treated with injectable therapies. Areas requiring further research are discussed.