Certain treatments for multiple sclerosis (MS) may cause hives or rashes in some people.

MS is a chronic condition that affects the brain and spinal cord, which are part of the central nervous system.

This article explores MS and its symptoms in more detail. It also describes treatment options and how they may affect the skin.

MS develops when the immune system blocks nerve fibers and the myelin sheath, the fatty substance that protects the nerve cells.

There are about 2.8 million people with MS around the world.

Forms

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 (RRMS): RRMS causes episodes that improve, with some residual effects. During episodes, symptoms can worsen, or new symptoms may appear. This form of MS is lifelong, and episodes 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 episodes.
  • 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.

MS can be mild, but in some cases, people may not be able to speak, write, or walk anymore.

The National Institute of Neurological Disorders and Stroke states that the disorder is unpredictable, and the first symptoms, such as decreased or blurry vision, may appear when a person is 20–40 years old.

People who have MS may experience several symptoms, including:

These symptoms may improve for some time but come back later on. Sometimes, these symptoms may also worsen.

Matthew’s story: MS and my skin

“I was diagnosed with secondary progressive MS in 2020. It has affected my skin in multiple ways, including the skin on my extremities becoming dark and dry. This is because my left leg and arm are severely compromised, meaning I cannot move them as much as my blood flow is somewhat compromised.

Also, my skin often crawls and itches, particularly when my body temperature rises quickly. This is a very common MS symptom, though I have multiple coping strategies for this challenge.”

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Diagnosing MS

It is important for a person to see a doctor if their symptoms are causing discomfort or interfering with their routine.

According to the National Multiple Sclerosis Society, neurological damage can also occur in the early stages of MS, 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
  • determine 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.

The following drugs 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. Examples include:
  • Corticosteroids: Drugs such as prednisone may help reduce inflammation and itching.
  • Anti-itch lotions or creams: 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.

Read more about MS treatment guidelines.

While MS does not cause skin symptoms, some MS medications can affect the skin, causing the following:

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, such as:

Omalizumab side effects

Omalizumab injections may cause side effects.

At the injection site

For example, people may experience the following in the skin at the injection site:

  • pain
  • redness or discoloration
  • swelling
  • a burning sensation
  • bruising

Other side effects

The injections may also cause the following:

Serious side effects

Some side effects can be serious, such as:

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 a 40-year-old female 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

Doctors may also prescribe dimethyl fumarate for MS. It decreases inflammation and prevents nerve damage.

Doctors may prescribe it to people with relapsing forms of MS. However, it may cause side effects affecting the skin, such as:

  • itching
  • redness or discoloration
  • hives
  • rashes

Azathioprine side effects

Azathioprine is another MS drug that can cause skin symptoms. Side effects may include:

Below are some drugs that can potentially cause skin effects and additional symptoms.

Corticosteroids

Short-term side effects of corticosteroids are usually mild and tend to disappear after a person finishes treatment.

Potential effects with short-term use

Potential side effects affecting the skin include rashes and flushed skin. Additional effects which affect the rest of the body are:

Potential effects with long-term use

Long-term steroid treatment may lead to further potential side effects affecting the skin, such as acne. It may also cause the following complications:

It is best for people to discuss the potential side effects of steroids with a doctor before starting treatment.

Antihistamines

Antihistamines do not tend to affect the skin. Potential side effects of drowsy antihistamines include:

  • drowsiness
  • 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. This means that doctors administer the medication intravenously.

Azathioprine

This drug is also an example of a DMT, but people take it orally.

A person with MS may be at risk of several conditions, including:

Neurological pain

The National Multiple Sclerosis Society notes that it is common for people with MS to experience numbness or a sensation of pins and needles. 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 severely affect quality of life.

Treatment can include medications such as antidepressants and anticonvulsants. Some people might also benefit from:

Pressure ulcers

People who are immobile due to MS, either in a wheelchair or in bed for prolonged periods, 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 areas may cause pain. If sensation is impaired, they might not be painful, which may lead them to go unnoticed and get worse. If left untreated, pressure ulcers can cause serious health problems and extend to the fatty tissue or bone.

Prevention involves scheduling times to change positions and using soft padding on bony areas. If a skin sore begins to develop, a healthcare professional will need to treat it promptly to avoid an infection from developing.

Risk of autoimmune diseases

Comorbidities are common in people with MS, including:

Skin symptoms are not part of MS itself, but autoimmune diseases can cause these symptoms to occur.

The following strategies may help people who experience neuropathy-related pain, discomfort, and altered sensations:

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.

Multiple sclerosis resources

Visit our dedicated hub for more research-backed information and in-depth resources on multiple sclerosis (MS).

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Multiple sclerosis (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 due to certain MS treatments. If medication is causing skin symptoms, doctors may recommend other medications to help relieve and reduce itching, such as creams, antihistamines, or injectables.