title: Sclerosing skin disorders in association with multiple sclerosis. Coincidence, underlying autoimmune pathology or interferon induced?
abstract: OBJECTIVE
  To describe and analyse the manifestation of sclerosing skin disorders in patients with multiple sclerosis (MS).
  
  
  METHODS
  We describe three patients with relapsing-remitting MS who developed skin sclerosis while receiving interferon (IFN)-beta treatment and review nine further cases of systemic sclerosis (SSc) in MS from the literature. Of all 12 patients reported, eight had limited cutaneous SSc, three had diffuse cutaneous SSc and one patient had an antisynthetase syndrome. Localised scleroderma such as morphoea was not described. The mean age at diagnosis was 25.2 years for MS (range 12 to 51) and 38.3 years for SSc (range 16 to 66). Eleven patients developed SSc after the onset of MS and manifested with skin sclerosis after a mean of 14.9 years (range 1 to 45). In five patients IFN-beta was commenced before the development of skin sclerosis (mean 4.6 years, range 1 to 8 years). There was no relationship between the onset of skin sclerosis and MS activity. With the exception of one individual, all patients had antinuclear antibodies.
  
  
  CONCLUSIONS
  Sclerosing skin disorders may develop in the course of MS. The relatively early age of SSc onset in patients with MS suggests a genetic predisposition and/or an IFN-associated trigger.
authors.affiliation: Felix Platter Spital, Basel University Department of Rheumatology, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Hügle
authors.forename: S
authors.initials: S
authors.lastname: Gratzl
authors.forename: T
authors.initials: T
authors.lastname: Daikeler
authors.forename: D
authors.initials: D
authors.lastname: Frey
authors.forename: A
authors.initials: A
authors.lastname: Tyndall
authors.forename: U A
authors.initials: UA
authors.lastname: Walker
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006801:Humans; D016899:Interferon-beta / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000276:immunology; D011928:Raynaud Disease / Q000150:complications / Q000276:immunology; D045743:Scleroderma, Diffuse / Q000150:complications* / Q000276:immunology; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D016899:Interferon-beta