Virus-induced epithelial lesions during fingolimod: HPV-related genital warts and molluscum contagiosum-case series and literature review.

Fingolimod is an immunosuppressive drug widely used to manage relapsing-remitting multiple sclerosis (RRMS), which is associated with increased rates of viral infections. We described 3 cases of viral skin infections related to fingolimod therapy. One of them developed cervical dysplasia. The first case is a 26-year-old woman with RRMS who developed anogenital warts 11 and a half years after using fingolimod. The second case is a 44-year-old woman with RRMS who developed genital warts four years after the onset of receiving fingolimod. Pap smear testing confirmed low-grade squamous intraepithelial dysplasia, with positive human papillomavirus (HPV) types 18 and 45. A year later, she developed genital molluscum contagiosum. The third case is a 28-year-old man with RRMS after six years of starting fingolimod, who developed widespread molluscum contagiousum, which resolved with no recurrence after fingolimod cessation. In conclusion, fingolimod treatment is associated with an increased risk of molluscum contagiosum, HPV infections, and HPV-associated dysplasia in RRMS patients. Periodic clinical surveillance and HPV vaccination are recommended for patients receiving fingolimod therapy.