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Dermatomyositis
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.
high blood pressure
Treatments whose long-term effectiveness isn't known include:
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.
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.
Dermatomyositis
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Disclaimer
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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