Cutaneous adverse reactions following alemtuzumab therapy for multiple sclerosis

Alemtuzumab (Lemtrada) is an immune suppressant medication used to treat multiple sclerosis (MS). We report on the spectrum of cutaneous adverse reactions, and mechanisms for these. We also report, with pictures, on a case example of a 32 year old man with MS who developed a nummular dermatitis on the trunk and pustular eruption due to Malassezia folliculitis occurring in the weeks following Lemtrada therapy, both on initial dosing and 1 year later.
Alemtuzumab is a CD52 monoclonal antibody first used in treatment of MS in 1991. It is often given with corticosteroid prophylaxis against infusion reaction. It results in severe T cell depletion, and has an associated increased risk of infection, and is associated with a late (2-3 years) increase in risk of other autoimmune diseases, for example Graves’ disease.
Cutaneous eruptions are reported to be common following Lemtrada (53%) and include pruritis, urticaria, dermatitis, hyperhidrosis, bullous eruption and maculopapular eruption.
We conducted a review of reported cutaneous side effects to establish the range of reactions, and their frequency.

Dr. Antonia Laino