A 20-year-old woman had a history of psoriasis and psoriatic arthritis since childhood. He started treatment with etanercept (Enbrel®) 1 month earlier. A day after a subcutaneous injection in her left thigh, she developed a mildly itchy rash on her right thigh, at the site of a previous injection.
There is an indurated erythematous plaque on the anterior component of the right thigh. There are adjacent bruises (see Figure 1).
Slightly indurated erythematous plaque on the anterior aspect of the right thigh with adjacent hematomas.
Etanercept (Enbrel®) is an injectable fusion protein that competitively inhibits the pro-inflammatory cytokine TNF-α. It is approved for use in the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and adults with moderate to severe diseases. Chronic plaque psoriasis. In clinical trials, the most common side effect of this remedy was injection site reaction (ISR). This can occur in up to 49% of patients and often presents as erythema, pruritus, pain, or edema. 7% of patients extend an “ISR booster” or reaction at a previous treatment site with subsequent injections.
Etanercept injection site reactions occur regularly within the first month of treatment. They occur no more than 1 to 2 days after injection and usually last 3 to 5 days. The frequency of CRS decreases with continuous treatment in the vast majority of patients, although it is persistent. or a worsening of the reaction has been described.
Most ISRs resolve without treatment, but symptomatic eruptions can be treated with cold compresses, topical corticosteroids, oral antihistamines, or acetaminophen. Discontinuing treatment with etanercept is rarely indicated.
Instruct patients to avoid administering etanercept to the ISR area. Future injections will be administered at least one inch from the outer edge of the ISR. Rotation of injection sites is also recommended. Recommended sites come with the front of the thighs, the outside of the arms, and the stomach two inches or more from the abdominal button. Injections should not be administered into psoriasis skin lesions. Signs and symptoms of infection should be discussed with the patient.
Make sure patients perceive that an SRI will occur and that it is not similar to the disease process. The proper injection strategy should be reviewed and patients should be invited to contact their physician if they experience itching, pain, swelling, or severe symptoms. of infection.
Dermatological nursing. 2005; 17(5):375 2005 © Jannetti Publications, Inc.
Susan Clelland, BSN, RN, is a nurse manager at Henry Ford Hospital in Detroit, Michigan.
Slightly indurated erythematous plaque on the anterior aspect of the right thigh with adjacent hematomas.
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