We present a case of a 30-year-old man with relapsing-remitting multiple sclerosis who developed psoriasiform dermatitis following his second course of ocrelizumab. This resolved with topical therapies and discontinuation of treatment. Cases of psoriasiform rashes have been increasingly reported in the use of ocrelizumab and are possibly due to B-cell (CD20) depletion and T-cell overregulation. Nevertheless, skin-related adverse reactions are not yet considered in the risk management plans of anti-CD20 treatments in multiple sclerosis.
HauserSLBar-OrAComiG, et al. Ocrelizumab versus interferon Beta-1a in relapsing multiple sclerosis. N Engl J Med2017; 376: 221–234.
2.
WolinskyJSArnoldDLBrochetB, et al. Long-term follow-up from the ORATORIO trial of ocrelizumab for primary progressive multiple sclerosis: A post-hoc analysis from the ongoing open-label extension of the randomised, placebo-controlled, phase 3 trial. Lancet Neurol2020; 19(12): 998–1009.
3.
BalakDMHengstmanGJÇakmakA, et al. Cutaneous adverse events associated with disease-modifying treatment in multiple sclerosis: A systematic review. Mult Scler2012; 18: 1705–1717.
4.
DarwinERomanelliPLev-TovH. Ocrelizumab-induced psoriasiform dermatitis in a patient with multiple sclerosis. Dermatol Online J2018; 24: 13030.
5.
Jakob BreclGGabelićTRuškaB, et al. Psoriasis caused by ocrelizumab in two persons with primary progressive multiple sclerosis. Int J Dermatol2022; 61(9): e322–e324.
6.
SankariSEVan EsscheCvan PeschV. Cutaneous diseases related to a hyperactive T-cell response in ocrelizumab-treated multiple sclerosis patients. J Neurol2021; 268(11): 4376–4378.
7.
LappiACammarataENicolaS, et al. Palmoplantar pustular psoriasis induced by ocrelizumab in a patient affected by multiple sclerosis. Ital J Dermatol Venerol2022; 157(5): 459–460.
8.
SirbuCAIvanRVasileTM, et al. Cutaneous adverse reactions associated with monoclonal antibodies treatment in multiple sclerosis: Case reports and short literature review. J Clin Med2022; 11: 3702.
9.
KlumppALuessiFEngelS, et al. Ocrelizumab-induced vulvovaginal pyoderma gangrenosum in a patient with relapsing-remitting multiple sclerosis. JAAD Case Rep2022; 28: 24–27.
10.
PorwalMHPatelDMaynardM, et al. Disproportional increase in psoriasis reports in association with B cell depleting therapies in patients with multiple sclerosis. Mult Scler Relat Disord2022; 63: 103832.
11.
KwokTLooWJGuentherL. Psoriasis and multiple sclerosis: Is there a link?J Cutan Med Surg2010; 14: 151–155.
12.
PatrickMTNairRPHeK, et al. Shared genetic risk factors for multiple sclerosis/psoriasis suggest involvement of Interleukin-17 and Janus Kinase-signal transducers and activators of transcription signaling. Ann Neurol2023; 94(2): 384–397.
13.
RendonASchäkelK. Psoriasis pathogenesis and treatment. Int J Mol Sci2019; 20: 1475.
14.
KristjánssonVBLundSHGröndalG, et al. Increased risk of inflammatory bowel disease among patients treated with rituximab in Iceland from 2001 to 2018. Scand J Gastroenterol2021; 56(1): 46–52.
15.
BenevidesLCostaRSTavaresLA, et al. B lymphocyte-induced maturation protein 1 controls TH9 cell development, IL-9 production, and allergic inflammation. J Allergy Clin Immunol2019; 143(3): 1119–1130.
16.
SchlapbachCGehadAYangC, et al. Human TH9 cells are skin-tropic and have autocrine and paracrine proinflammatory capacity. Sci Transl Med2104; 6: 219ra8.
17.
MorrisonPJSuhrkampIGerdesS, et al. Oral dimethyl fumarate induces changes within the peripheral neutrophil compartment of patients with psoriasis that are linked with skin improvement*. Br J Dermatol2021; 185(3): 605–615.
18.
Di TullioFOdoriciGLasagniC, et al. Combination treatment with secukinumab and dimethyl fumarate in a patient with psoriasis and recent diagnosis of multiple sclerosis. Dermatol Ther2020; 33(6): e13943.
19.
RolfesLPfeufferSHackertJ, et al. Skin reactions in patients with multiple sclerosis receiving cladribine treatment. Neurol Neuroimmunol Neuroinflamm2021; 8(3): e990.