title: Extracorporeal shock wave therapy for injection site panniculitis in multiple sclerosis patients.
abstract: BACKGROUND
  Painful cutaneous injection site reactions may hamper treatment with interferon β (IFN-β) and glatiramer acetate (GA) in multiple sclerosis (MS) patients.
  
  
  OBJECTIVE
  To maintain therapy adherence, efficient therapeutic modalities for these subcutaneous inflammatory lesions are urgently needed. We tested the application of local extracorporeal shock wave therapy (ESWT).
  
  
  METHODS
  We applied 5 sessions of ESWT to 8 patients suffering from MS who had developed painful panniculitis at the injection sites of either IFN-β or GA. Clinical outcomes, i.e. pain reduction and regression of induration, were assessed 3 and 6 months after completion of the ESWT using a visual analogue score.
  
  
  RESULTS
  All patients showed both significant pain reduction and reduction of the skin induration in the treated lesions, while in untreated control lesions there was no improvement.
  
  
  CONCLUSIONS
  ESWT proved to be a non-invasive, safe and efficient physical treatment modality for injection-induced painful cutaneous side effects of disease-modifying drugs in MS.
authors.affiliation: Department of Dermatology, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Stieger
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.forename: Nikhil
authors.initials: N
authors.lastname: Yawalkar
authors.forename: Thomas
authors.initials: T
authors.lastname: Hunziker
mesh_terms: D000328:Adult; D005260:Female; D000068717:Glatiramer Acetate; D019220:High-Energy Shock Waves; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007273:Injections, Intramuscular / Q000009:adverse effects; D007279:Injections, Subcutaneous / Q000009:adverse effects; D016899:Interferon-beta / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D015434:Panniculitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects*; D014464:Ultrasonic Therapy; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta