Management of cutaneous dermatomyositis

Abstract

Dermatomyositis (DM) is traditionally classified as an idiopathic inflammatory myopathy distinguished by muscle weakness and characteristic cutaneous findings. Patients presenting with the skin manifestations in the absence of clinical evidence of muscle weakness are categorized as clinically amyopathic DM. The symptoms associated with the cutaneous findings can be particularly debilitating, and a discordant response to therapy exists between muscle and skin disease. Various therapeutic agents and treatment approaches have been described, both for the cutaneous and extracutaneous manifestations; however, a paucity of controlled studies in this disease leads to limitations in interpreting the available data. In this review, emphasis is placed specifically on summarizing the current literature regarding management of cutaneous DM. In addition, an algorithmic approach to treatment of skin disease is presented.

Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists

“…Oral antihistamines are also used for pruritus (evidence level VI). 181,182 For severe skin symptoms, systemic administration of dapsone (DDS) (recommendation grade: C1), IVIg (C1), MTX (C1), MMF (C1), CsA (C1) or Tac (C1) may be considered.…”

“…If the patient has extensive skin symptoms impairing quality of life, systemic therapy may be taken into consideration for the prolonged skin symptoms after the conventional treatment for other organs (evidence level VI). 181,182 No systemic therapy has been proven effective by RCT.…”

Special papers Diagnostic and therapeutic advances in dermatomyositis

“…W takich przypadkach rekomenduje się wcześniejsze dołączenie leku immunosupresyjnego (ang. steroid-sparing agent), a także intensyfikację terapii miejscowej [49,50]. Istnieje randomizowane badanie kliniczne porównujące terapię pulsową doustnym deksametazonem (6 cykli po 40 mg/dobę przez 4 kolejne dni z 28-dniową przerwą) z terapią ciągłą prednizolonem (początkowa dawka 70-90 mg/dobę w zależności od masy ciała), przy stopniowo zmniejszanej dawce stosowanej przez 44-52 tygodni.…”

“…Ich skuteczność w terapii zmian skórnych związanych z DM sięga 75%, jednak nie są one skuteczne w odniesieniu do objawów mięśniowych [49]. Ze względu na wysoki profil bezpieczeństwa tej grupy leków mogą one być rekomendowane w klasycznym DM przebiegającym z opornymi na leczenie zmianami skórnymi jako lek dodatkowy, a także w ADM.…”

Treatment of Chronic Facial Erythema of Dermatomyositis with Intense Pulsed Light Therapy

“…1 For the treatment of theses cutaneous lesions, topical steroids and topical calcineurin inhibitors are commonly used, while systemic agents such as glucocorticoids, antimalarials and methotrexate may be used in refractory cases. 2 Despite all these treatments, cutaneous lesions may persist, causing severe impacts on patient's quality of life. To our knowledge, this is the first report of intense pulsed light (IPL) used in the treatment of the persistent facial erythema in cutaneous dermatomyositis.…”