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Dermatomyositis
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Dermatomyositis

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WOMEN'S HEALTH

Hair/Nails/Skin

Although dermatomyositis may occur at any age, it mostly affects adults in their late 40s to early 60s or children between 5 and 15 years of age. Women have it more often than men do. Dermatomyositis in children is distinct from the adult form. The disease usually develops over weeks or months.

Dermatomyositis is a relatively rare disease marked by muscle weakness and a distinctive skin rash. Because of similarities in signs, symptoms and treatment, it's often discussed in conjunction with polymyositis. Both conditions fall into the category of inflammatory muscle diseases - myo means "muscles" in Greek; itis means "inflamed." Derma, which means "skin," implies the skin-related signs and symptoms that accompany the muscle inflammation.

 

Treatment

Although there's no cure for dermatomyositis, treatment can improve your skin, muscle strength and function. Treatment begun early in the disease process tends to be more effective, often because there are fewer complications. Methods of therapy include the following:

  • Corticosteroids. These medications suppress your immune system, limiting the production of antibodies and reducing skin and muscle inflammation. Corticosteroids, especially prednisone (Deltasone), are usually the first choice in treating inflammatory myopathies such as dermatomyositis. Your doctor may start with a very high dose, then decrease it as your signs and symptoms improve. This generally takes about two to four weeks. Your doctor may also prescribe topical corticosteroids for your skin. Significant results are usually evident within three to six months, but therapy is often needed for years. Prolonged use of corticosteroids can have serious side effects including osteoporosis, weight gain, diabetes, increased risk of some infections, mood swings, cataracts, high blood pressure, a redistribution of body fat and muscle weakness. As a result, your doctor may also recommend supplements such as calcium and vitamin D and may prescribe bisphosphonates such as alendronate (Fosamax) or risedronate (Actonel). If you're postmenopausal, your doctor may prescribe estrogen to reduce the risk of osteoporosis.

  • Immunosuppressants. If your body doesn't respond adequately to corticosteroids, your doctor may recommend other immunosuppressive drugs such as azathioprine (Imuran) or methotrexate (Folex, Rheumatrex). Your doctor may prescribe these alone or in combination with corticosteroids. When in combination, these additional immunosuppressants can be used to lessen the dose and potential side effects of the corticosteroid. Immunosuppressants such as cyclophosphamide (Cytoxan, Neosar) and cyclosporine (Neoral, Sandimmune) may improve signs and symptoms of dermatomyositis and interstitial lung disease.

  • Antimalarial medications. For a persistent rash, your doctor may prescribe an antimalarial medication such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen). Be aware, however, that adverse reactions to such medications, though uncommon, can be confused with the rash or weakness of dermatomyositis.

  • Intravenous immunoglobulin (IVIg). This involves receiving intravenous infusions of antibodies from a group of donors over two to five days. This treatment may be an option for you if your dermatomyositis is severe or resistant to other forms of therapy.

  • Physical therapy. A physical therapist can show you various exercises to maintain and improve your strength and flexibility and advise an appropriate level of activity. Your exercise program is likely to change during the course of the disease and treatment period. Keeping active in general and pacing yourself will help maintain muscle strength.

  • Surgery. Surgery may be an option to extract painful calcium deposits.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter drugs such as aspirin, ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) can be used to treat any accompanying pain. If these aren't sufficient, your doctor may prescribe a stronger pain reliever, such as codeine.

Treatments whose long-term effectiveness isn't known include:

  • Plasmapheresis. This treatment, also called plasma exchange, is a type of blood cleansing in which damaging antibodies are removed from your blood.

Therapeutic plasmapheresis is a process in which the fluid part of the blood, called plasma, is removed from blood cells by a device known as a cell separator.

  • Radiation therapy. This involves irradiation of the lymph nodes, a part of the immune system.

Treatments that are still in the experimental phase but have shown signs of being effective include fludarabine (Fludara), an agent that prevents the development and growth of malignant cells, and tacrolimus (Prograf), a transplant-rejection drug.

 

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/15/08 12:14 AM