Causes and Clinical Presentation of Drug-Induced Dermatomyositis

Abstract

ImportanceWhile several medications are known to induce dermatomyositis (DM), most existing studies are case reports or small case series from a single institution. There is also limited information on DM induced by immune checkpoint inhibitors, which are increasingly used in oncologic therapy.ObjectiveTo characterize causes and clinical presentation of drug-induced DM based on the current literature.Evidence ReviewA systematic review was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, from inception to August 22, 2022. Articles meeting preestablished inclusion criteria (written in English and classified as original articles, case reports, literature reviews, and observation letters) were selected and data abstracted. Articles that met the scope of the review were also added from reference lists. When possible, study results were quantitatively combined.FindingsIn 134 studies (114 from the literature search and 20 additional studies pulled from reference lists) describing 165 cases, 88 patients (53.3%) were female, and the median (IQR) age was 61 (49-69) years. Among the cases of drug-induced DM, the most common associated medications were hydroxyurea (50 [30.3%]), immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and tumor necrosis factor inhibitors (10 [6.1%]). Histopathologic testing, when undertaken, helped establish the diagnosis. There was a median (IQR) of 60 (21-288) days between drug initiation and drug-induced DM onset. History of cancer was reported in 85 cases (51.6%).Conclusions and RelevanceIn this systematic review, drug-induced DM was associated with multiple types of medications, including chemotherapies and immunotherapies. It is essential that dermatologists promptly recognize and diagnose drug-induced DM so that they can guide management to minimize interruption of therapy when possible.

Violaceous scaly plaques of the dorsal hands

“…Other culprit medications include immune checkpoint inhibitors such as ipilimumab, pembrolizumab, or nivolumab; statins and penicillamine. 5 Trimethoprim-sulfamethoxazole – Incorrect. Although implicated in cases of Stevens-Johnson syndrome/toxic epidermal necrolysis and fixed drug eruption, to our knowledge, there are no reports cases of trimethoprim-sulfamethoxazole-induced DM.…”

“…Other culprit medications include immune checkpoint inhibitors such as ipilimumab, pembrolizumab, or nivolumab; statins and penicillamine. 5 …”