Endermology: a treatment for injection-induced lipoatrophy in multiple sclerosis patients treated with sub cutaneous glatiramer acetate

Objective

To evaluate sessions of endermology (LPG) on patients with lipoatrophy, due to GA injections in an open-labelled study.

Background

Glatiramer acetate (GA) is an immunomodulatory drug, with an excellent safety profile, that is currently used for treatment of multiple sclerosis and is administered as daily subcutaneous injections of 20 mg. The most common adverse effects, which occur in approximately 20–60% of the patients, include pain, inflammation and induration at the injection sites. Another adverse effect is frank panniculitis followed by localized lipoatrophy at the injection sites, which has been described in half of the patients receiving treatment with glatiramer acetate injections. No treatment has been found for established lipoatrophy.

Patients and methods

All patients underwent LPG twice a week during 30 min. A cycle of two months was initially proposed. If the patient was satisfied with the result, sessions were continued with one session per week until the 4th month.

Results

Eight Patients treated with GA and presenting with lipoatrophy were prospectively recruited. None of them complained of any adverse events. After 8 weeks of treatment, all had a visible reduction of lipoatrophic area. MRI showed no major subcutaneous changes except for a reduction in and repartition of fatty tissues.

Conclusion

The LPG cellu M6 keymodule is a mechanotransduction machine that stimulates the skin's surface in triggering cells to activate lipolysis and collagen production. It has never been used for treatment of lipoatrophy due to drug treatment or in specific diseases associated with lipoatrophy (diabetes, HIV). The prevention and management of lipoatrophy includes patient education, regular examination and manual palpation of all injection sites. LPG endermology can help patients to resolve this side effect and to continue immunomodulatory treatment.