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Dermatomyositis

 

Dermatomyositis is a muscle disease that involves inflammation and a skin rash. Polymyositis is a similar inflammatory condition, that also involves muscle weakness, swelling, tenderness, and tissue damage but no skin rash. Both are part of a larger group of disease called inflammatory myopathy.

Causes

The cause of dermatomyositis is unknown. Experts think it may be due to a viral infection of the muscles or a problem with the body's immune system. It may also occur in people who have cancer in the abdomen, lung, or other parts of the body.

Anyone can develop this condition. It most often occurs in children age 5 to 15 and adults age 40 to 60. It affects women more often than men.

Symptoms

 

Symptoms may include:

  • Muscle weakness, stiffness, or soreness
  • Problems swallowing
  • Purple color to the upper eyelids
  • Purple-red skin rash
  • Shortness of breath

The muscle weakness may come on suddenly or develop slowly over weeks or months. You may have trouble raising your arms over your head, getting up from a sitting position, and climbing stairs.

The rash may appear on your face, knuckles, neck, shoulders, upper chest, and back.

 

Exams and Tests

 

The health care provider will do a physical exam. Tests may include:

  • Bloods test to check levels of muscle enzymes called creatine phosphokinase and aldolase
  • Blood tests for autoimmune diseases
  • ECG
  • Electromyography (EMG)
  • Magnetic resonance imaging (MRI)
  • Muscle biopsy
  • Skin biopsy
  • Other screening tests for cancer
  • Chest x-ray and CT scan of the chest
  • Lung function tests
  • Swallowing study
  • Myositis specific and associated autoantibodies

 

Treatment

 

The main treatment is the use of corticosteroid medicines. The dose of medicine is slowly tapered off as muscle strength improves. This takes about 4 to 6 weeks. You may stay on a low dose of a corticosteroid medicine after that.

Medicines to suppress the immune system may be used to replace the corticosteroids. These drugs may include azathioprine, methotrexate or mycophenolate.

Treatments that may be tried when disease that remains active in spite of these medicines are:

  • Intravenous gamma globulin
  • Biologic drugs

When your muscles get stronger, your provider may tell you to slowly cut back on your doses. Many people with this condition must take a medicine called prednisone for the rest of their lives.

If a cancer is causing the condition, the muscle weakness and rash may get better when the tumor is removed.

 

Outlook (Prognosis)

 

Symptoms may go away completely in some people, such as children.

The condition may be fatal in adults due to:

  • Severe muscle weakness
  • Malnutrition
  • Pneumonia
  • Lung failure

The major causes of death with this condition are cancer and lung disease.

People with lung disease with the anti-MDA-5 antibody have a poor prognosis in spite of current treatment.

 

Possible Complications

 

Complications may include:

  • Lung disease
  • Acute renal failure
  • Cancer (malignancy)
  • Inflammation of the heart
  • Joint pain

 

When to Contact a Medical Professional

 

Call your provider if you have muscle weakness or other symptoms of this condition.

 

 

References

Aggarwal R, Rider LG, Ruperto N, et al. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Adult Dermatomyositis and Polymyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol. 2017;69(5):898-910. PMID: 28382787 www.ncbi.nlm.nih.gov/pubmed/28382787.

Dalakas MC. Inflammatory muscle diseases. N Engl J Med. 2015;373(4):393-394. PMID: 26200989 www.ncbi.nlm.nih.gov/pubmed/26200989.

Nagaraju K, Gladue HS, Lundberg IE. Inflammatory diseases of muscle and other myopathies. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 85.

National Organization for Rare Disorders website. Dermatomyositis. rarediseases.org/rare-diseases/dermatomyositis/. Accessed April 1, 2019.

Text only

 
  • Dermatomyositis - Gottron papule

    Dermatomyositis - Gottron papule - illustration

    Red, thickened, scaly skin over the knuckles (Gottron sign) associated with dermatomyositis, an autoimmune disease of the skin and muscles.

    Dermatomyositis - Gottron papule

    illustration

  • Dermatomyositis - Gottron's papules on the hand

    Dermatomyositis - Gottron's papules on the hand - illustration

    This violet-colored inflammation (erythema) over the knuckles is caused by Dermatomyositis. Other skin conditions produce more redness, while the color of this lesion is violet. There may also be inflammation in the muscle tissue.

    Dermatomyositis - Gottron's papules on the hand

    illustration

  • Dermatomyositis - heliotrope eyelids

    Dermatomyositis - heliotrope eyelids - illustration

    This photograph demonstrates the sign heliotrope eyelids in which the eyelids develop a brown (violaceous - rather than red) color. Heliotrope eyelids and Gottron's papules on the knuckles are characteristic findings in dermatomyositis.

    Dermatomyositis - heliotrope eyelids

    illustration

  • Dermatomyositis on the legs

    Dermatomyositis on the legs - illustration

    The appearance of purple (violaceous) plaques on the knees may be associated with dermatomyositis. Typically, most lesions associated with other diseases are red (erythematous).

    Dermatomyositis on the legs

    illustration

  • Dermatomyositis - Gottron papule

    Dermatomyositis - Gottron papule - illustration

    This is Gottron sign, seen in dermatomyositis (an inflammatory disease of the muscles and skin). Violet-colored inflammation over the knuckles is an important diagnostic finding in dermatomyositis, since other skin conditions produce more redness.

    Dermatomyositis - Gottron papule

    illustration

  • Paronychia - candidial

    Paronychia - candidial - illustration

    Candida paronychia produced periungual erythema, edema and nail fold maceration.

    Paronychia - candidial

    illustration

  • Dermatomyositis - heliotrope rash on the face

    Dermatomyositis - heliotrope rash on the face - illustration

    Dermatomyositis, a connective tissue disease, typically produces a reddish-purple (violaceous) rash. The rash is named after the tendency of plants to grow toward the sun (heliotropic) and is characteristic of dermatomyositis.

    Dermatomyositis - heliotrope rash on the face

    illustration

    • Dermatomyositis - Gottron papule

      Dermatomyositis - Gottron papule - illustration

      Red, thickened, scaly skin over the knuckles (Gottron sign) associated with dermatomyositis, an autoimmune disease of the skin and muscles.

      Dermatomyositis - Gottron papule

      illustration

    • Dermatomyositis - Gottron's papules on the hand

      Dermatomyositis - Gottron's papules on the hand - illustration

      This violet-colored inflammation (erythema) over the knuckles is caused by Dermatomyositis. Other skin conditions produce more redness, while the color of this lesion is violet. There may also be inflammation in the muscle tissue.

      Dermatomyositis - Gottron's papules on the hand

      illustration

    • Dermatomyositis - heliotrope eyelids

      Dermatomyositis - heliotrope eyelids - illustration

      This photograph demonstrates the sign heliotrope eyelids in which the eyelids develop a brown (violaceous - rather than red) color. Heliotrope eyelids and Gottron's papules on the knuckles are characteristic findings in dermatomyositis.

      Dermatomyositis - heliotrope eyelids

      illustration

    • Dermatomyositis on the legs

      Dermatomyositis on the legs - illustration

      The appearance of purple (violaceous) plaques on the knees may be associated with dermatomyositis. Typically, most lesions associated with other diseases are red (erythematous).

      Dermatomyositis on the legs

      illustration

    • Dermatomyositis - Gottron papule

      Dermatomyositis - Gottron papule - illustration

      This is Gottron sign, seen in dermatomyositis (an inflammatory disease of the muscles and skin). Violet-colored inflammation over the knuckles is an important diagnostic finding in dermatomyositis, since other skin conditions produce more redness.

      Dermatomyositis - Gottron papule

      illustration

    • Paronychia - candidial

      Paronychia - candidial - illustration

      Candida paronychia produced periungual erythema, edema and nail fold maceration.

      Paronychia - candidial

      illustration

    • Dermatomyositis - heliotrope rash on the face

      Dermatomyositis - heliotrope rash on the face - illustration

      Dermatomyositis, a connective tissue disease, typically produces a reddish-purple (violaceous) rash. The rash is named after the tendency of plants to grow toward the sun (heliotropic) and is characteristic of dermatomyositis.

      Dermatomyositis - heliotrope rash on the face

      illustration

    Tests for Dermatomyositis

     
       

      Review Date: 1/10/2019

      Reviewed By: Gordon A. Starkebaum, MD, MACR, ABIM Board Certified in Rheumatology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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