A narrative review of therapies for scalp dermatomyositis

Abstract

Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous DM negatively impacts quality-of-life, scalp symptoms in particular are often severe, debilitating, and recalcitrant to standard DM therapies. Currently, there is a paucity of guidelines to inform management of scalp symptoms in patients with cutaneous DM. In this narrative review, we summarize the treatments utilized to manage scalp DM and highlight potential areas for future research. We identified eight studies that reported on 27 treatments focused on cutaneous DM and described outcomes on scalp symptoms. A majority of the treatments were standard therapies for cutaneous DM and resulted in no or minimal improvement in scalp symptoms. Five therapies did result in complete resolution of scalp symptoms and were recommended as potential areas of future research. These included low-dose naltrexone and platelet-rich plasma, as well as two frequent and one less common therapy for cutaneous DM respectively: intravenous immunoglobulin, rituximab, and apremilast. Though the literature was not systematically assessed in this review, these findings illustrate not only that strategies for refractory scalp DM are lacking, but also that those demonstrating potential efficacy are limited by low levels of evidence. Additional studies, especially randomized controlled trials, are needed to better inform management of scalp DM.

Efficacy and safety of apremilast in a patient with paraneoplastic dermatomyositis with resistant skin disease

“…After the admission to our division, treatment with 1 mg/kg/day of intravenous methylprednisolone combined with high doses of intravenous immunoglobulins (0.4 mg/kg/day for 5 consecutive days) was started, however, with a scarce response on skin disease. Thus, given that most of the immunosuppressants are contraindicated in the course of chemotherapy, apremilast 30 mg twice daily was introduced while continuing chemotherapy, based on the already published experiences of apremilast in idiopathic, non-cancer related dermatomyositis (5)(6)(7)(8)(9). Starting from 2 months, skin disease significantly improved (CDASI 16 at month +3) and prednisone was tapered to 5 mg/day without relapse (Fig.…”

Avaliação morfológica e quantificação da densidade de fibras nervosas dermoepidérmicas no couro cabeludo sintomático de pacientes com dermatomiosite

“…A abordagem terapêutica do PCC na DM é a mesma terapia padrão proposta na DM como uso de corticoides sistêmicos ou tópicos, antihistamínicos, imunossupressores e imunoglobulina endovenosa. Contudo a maioria desses tratamentos falham em aliviar os sintonas em pacientes com PCC (Kolla et al, 2021).…”