Multiple sclerosis (MS) is a chronic condition that affects the brain and spinal cord, which are part of the central nervous system. Certain treatments for this condition may cause skin hives or rashes for some people.
This article explores MS and its symptoms in more detail, as well as treatment options and preventive measures.
MS develops when the immune system blocks nerve fibers and myelin sheath, the fatty substance that protects the nerve cells.
There are about 2.8 million people with MS around the world.
The different forms of MS include:
- Clinically isolated syndrome: This refers to the first episode of symptoms that people experience when there is an inflammation in the central nervous system. This may last 24 hours but does not always lead to MS.
- Relapsing-remitting MS: This form of MS causes attacks that improve, with some residual effects. During attacks, symptoms can worsen, or new symptoms may appear. This form of MS is lifelong, and attacks can last for weeks or months.
- Primary progressive MS: Those who have this type of MS experience gradually worsening symptoms, and they do not have frequent attacks.
- Secondary progressive MS: This type of MS begins with a pattern of relapsing-remitting MS for years, which then begins to change to a pattern of progressive MS.
Learn more about the types of MS here.
Symptoms of MS
MS can be mild, but in some cases, people may not be able to speak, write, or walk anymore.
People who have MS may experience several symptoms, including:
- muscle stiffness
- muscle spasms
- blurred vision
- problems with memory or concentration
These may improve for some time but come back later on. Sometimes, these symptoms may also worsen.
Diagnosis of MS
A person should see a doctor if their symptoms are causing discomfort or interfering with their routine. According to the National Multiple Sclerosis Society (NMSS), neurological damage can also occur in the early stages, so early treatment is important.
To diagnose MS, doctors need to do the following:
- Identify signs of damage to at least two separate areas of the central nervous system.
- Identify that the damage occurred at different points in time.
- Rule out other possible causes for the damage.
Doctors will take a person’s medical history and can perform neurological exams that test walking, balance, swallowing, and facial sensation. They may also use blood tests to rule out other potential conditions.
Drugs such as duloxetine, gabapentin, and carbamazepine may benefit people with neuropathic pain.
Doctors or dermatologists may also prescribe the following to treat hives:
- Antihistamines: These medications are available without a prescription. They can help reduce itching and swelling. These include:
- Corticosteroids: Drugs like prednisone may help reduce inflammation and itching.
- Anti-itch lotion or cream: These creams provide temporary relief when the skin is itchy, such as E45.
- Omalizumab: This drug is available as an injection and can help when antihistamines do not provide relief.
- Auto-injector: An EpiPen may benefit people with life threatening allergies.
While MS does not cause skin symptoms, some MS medications can cause skin symptoms, such as hives, rashes, and tingling.
Anti-itch lotion or cream side effects
Anti-itch creams tend to relieve itching symptoms, but creams such as E45 can also cause other skin-related symptoms:
- burning sensation
Omalizumab side effects
Omalizumab injection may cause side effects, such as:
- the skin on the injection site may have:
- pain in the:
- swelling inside of the:
- abdominal pain
Some side effects can be serious, such as:
- muscle aches
- swollen glands
- shortness of breath
- coughing up blood
- skin sores
- tingling in hands and feet
A person should consult immediate medical attention if they experience any of these symptoms after receiving the injection.
Alemtuzumab side effects
Alemtuzumab can cause skin itching and rashes. These symptoms usually disappear after the person stops the treatment.
A 2020 case study explains how one 40-year-old woman experienced hives and swelling on her lips and face after treatment with alemtuzumab. The symptoms lasted for 3 months, and the person also received treatment for hives.
Dimethyl fumarate side effects
Dimethyl fumarate is another drug doctors may prescribe for MS. It decreases inflammation and prevents nerve damage.
Doctors may prescribe it to people with relapsing forms of MS. However, side effects may affect the skin such as:
Azathioprine side effects
Azathioprine is another MS drug that can cause skin symptoms. Side effects may include:
- skin rashes
- liver toxicity
Below are some drugs that have the potential to cause skin effects, as well as additional symptoms.
Corticosteroid side effects
Short-term side effects of corticosteroids are usually mild and tend to disappear after a person finishes treatment.
Potential side effects affecting the skin include rash and flushed skin. Additional effects which affect the rest of the body are:
- a metallic taste in the mouth
- digestion issues such as indigestion and abdominal pain
- mood swings
- increased appetite
- heart palpitations
- chest pain
- edema of the ankles
Long-term steroid treatment may lead to further potential side effects and complications affecting the skin such as acne and:
- weight gain
A person should discuss the potential side effects of steroids with a doctor before starting treatment.
Antihistamine side effects
Antihistamine does not tend to affect the skin but potential side effects of drowsy antihistamines include:
- reduced coordination, reflexes, and judgment
- dry mouth
- blurred vision
- difficulty urinating
The side effects of nondrowsy antihistamines may include some of the above, as well as headaches, and sickness.
Alemtuzumab and dimethyl fumarate
These drugs are examples of disease-modifying therapy (DMT) to treat MS relapses. People receive them as an infusion where doctors administer the medication directly into a person’s veins (intravenous).
This drug is also an example of a DMT, but people take it orally.
There are a number of conditions that a person with MS may be at risk of, including:
The NMSS also notes that it is common for people with MS to have numbness or a pins and needles sensation. This can affect any part of the body.
Neurological pain in MS does not cause a rash or sores, but it can be severe. In some cases, it can feel like burning or it may have a serious effect on quality of life.
Treatment can include medications like antidepressants and anticonvulsants that are used to treat neuropathic pain. Some people might also benefit from:
- pain injections
- physical therapy
People who are immobile due to MS, in a wheelchair or in bed for prolonged periods of time can develop pressure ulcers. A pressure ulcer is an area of the skin or tissue that is dead or dying because blood has stopped flowing to the area.
These may cause pain, but if sensation is impaired it might not be painful, and that can cause it to be unnoticed and get worse. If left untreated, these can cause serious health problems, and extend to the fatty tissue or bone.
Prevention involves scheduling turning positions and using soft padding on bony areas. If any skin sore begin to develop, a healthcare professional should treat it promptly to avoid it becoming infected.
Risk of autoimmune diseases
Skin symptoms are not part of MS itself, but autoimmune diseases can cause these symptoms to occur.
For people who experience neuropathy-related pain, discomfort, and altered sensations, the following strategies may help:
- wearing loose clothing
- hot or cold therapy
- stretching exercises
- low impact physical activity
Avoiding skin symptoms due to medication may be difficult but talking with a doctor about a medication’s potential risks and side effects can help. Knowing the potential for skin reactions can make it easier to spot problems before they become severe.
MS is a health condition that affects the central nervous system.
Symptoms include muscle stiffness, spasms, and numbness.
Some people may also develop skin rashes, hives, or tingling because of certain MS treatments. If medication is causing skin symptoms, doctors may recommend medications to help relieve and reduce itching, such as creams, antihistamines, or injectables.