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Dermatomyositis - Causes, Symptoms, Diagnosis, and Treatment

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Dermatomyositis is a condition affecting skin and muscles. Read this article to know more about its causes, symptoms, diagnosis, and treatment.

Written by

Dr. Lochana .k

Medically reviewed by

Dr. Barve Vaibhav Saidas

Published At March 1, 2022
Reviewed AtDecember 22, 2022

Overview:

Dermatomyositis is an inflammatory condition. If inflammation occurs in response to any trauma, it is considered a usual phenomenon. But, in inflammatory disorders, the body's immune mechanism is known to act against the tissues of the individual. This creates a negative response to swelling and body pain. Some people might even experience stiffness, muscle weakness, and prolonged pain. There is no specific treatment for dermatomyositis. However, it is possible to relieve the symptoms to an extent. The skin rashes can also be cured and therapy can be given for improving muscle functions and strength.

What Is Dermatomyositis?

In medical terms, ‘derma’ refers to the skin, and ‘myo’ refers to the muscle. Myositis is the inflammatory condition of the muscles. This condition is known to affect all the age groups. The most common age group that are affected are people who belong to the late 40s and early 60s. The female gender is known to be affected more than the male. There is no specific reason for this. But, some reports show that it might be due to the poor stamina women have compared to men.

What Are the Causes of Dermatomyositis?

The condition of dermatomyositis occurs for an unknown reason. People who are known to be affected by autoimmune disorders have the possibility of getting this condition. Genetic influence can also be the cause of dermatomyositis. In some patients, the reason for dermatomyositis is the influence of environmental factors. The environmental factors include the following:

  • Viral infections.

  • Exposure to the sun.

  • A few medications.

  • Smoking habit.

What Are the Symptoms of Dermatomyositis?

In several cases, the initial sign is a distinctive skin rash on the face, chest, eyelids, knuckles, nail cuticle areas, elbows, or knees. The rashes will be in the form of patchy and usually in bluish-purple color.

Patients might also experience muscle weakness that gets more serious over weeks or months. This muscle weakness usually starts in your neck, hips, or arms and can be experienced on both sides of your body.

Other sign and symptoms that the patient might experience are:

  • Muscle tenderness.

  • Muscle pain.

  • Lung problems.

  • Problems swallowing.

  • Fatigue.

  • Deposition of hard calcium under the skin. This sign is mostly seen in children.

  • Fever.

  • Unintentional weight loss.

What Are the Complications of Dermatomyositis?

The skin problems and muscle weakness linked with dermatomyositis can cause numerous issues. Some of the typical complications involved in dermatomyositis are:

  • Gastric ulcers.

  • Skin ulcers.

  • Lung infections.

  • Malnutrition.

  • Difficulty breathing.

  • Weight loss.

  • Problems in swallowing.

  • Raynaud's phenomenon.

  • Cancer.

  • Connective tissue disorders like rheumatoid arthritis, lupus, Sjogren's syndrome, scleroderma.

  • Cardiovascular disorders.

If any of these problems have already occurred in the patient, the severity is known to increase after the occurrence of dermatomyositis. In children, deposition of calcium is known to occur as a complication.

What Is the Diagnostic Procedure to Identify Dermatomyositis?

The initial diagnosis of dermatomyositis starts with a patient's physical examination and medical history. The health care provider or doctor will first ensure the presence of underlying diseases such as cancer. Several tests are involved in diagnosing dermatomyositis, such as:

  • Blood Tests: These tests are done to examine the sign of muscle inflammation. Using this test, we can also ensure the abnormal proteins that are formed in auto-immune disease. The typical blood tests include antinuclear antibody and muscle enzyme creatine kinase.

  • Electromyography: Electromyography is a diagnostic procedure that is used for the identification of the electrical activity of the muscles. The procedure of electromyography is performed using a tool called an electromyogram. It is a highly effective method for identifying muscular dysfunction and nerve disorders. It can identify the problems in the transmission of nerve-to-muscle signals. Some patients report discomfort and pain during this procedure. This is due to the insertion of needle electrodes. It might be painful, like intramuscular injections. But, there are no medications injected during the procedure of electromyography. After the test is complete, the soreness will be found, which will last for one or two days. If a patient has poor tolerance to pain, this procedure is not recommended for them.

  • MRI: MRI refers to magnetic resonance imaging. As the name suggests, this procedure uses a strong magnetic field, accompanied by radio waves. This is useful for producing detailed images of the organs. The procedure usually lasts for less than 90 minutes. It is a painless procedure, and is recommended for patients who cannot cooperate with electromyography.

  • Chest X-ray: It is a simple diagnostic tool to identify any destruction or changes to the lung tissues.

  • Muscle or Skin Biopsy. A small piece of tissue is collected from the patient as a sample and sent to the laboratory for a diagnostic procedure. The results will be obtained after two to three days. The results are very sensitive, and it is the most reliable technique. However, a biopsy procedure will require recommendations from the doctor.

What Are the Treatment Options?

  • Medications:

    • Corticosteroids - Corticosteroid medications are beneficial in subsiding the symptoms of dermatomyositis. A higher dosage of Corticosteroids will help the patient control the symptoms. You should take this medication only when the doctor prescribes it. If there is involvement of the lungs, then medicines like Mycophenolate Mofetil are used. The other medicines that are known to be beneficial for the condition of dermatomyositis are Azathioprine and Methotrexate.

    • Rituximab - Rituximab is a common medication that is prescribed for patients with rheumatoid arthritis. This could be an excellent alternative if the primary methods of treatment are not helpful.

    • Hydroxychloroquine - It is an anti-malarial drug that can be given to patients who have rashes in the skin for a prolonged duration.

  • Therapy:

    • Speech Therapy - If the patient is having difficulty swallowing, then there are possibilities of the speech to be affected. In such cases, speech therapy is essential.

    • Physical Therapy - This will help the person who performs exercises. It will improve the flexibility of the body and also enhance the strength of the muscles. Patients must follow a balanced diet.

  • Surgery: A surgical method is recommended for patients who are having calcium deposits. These deposits are removed by surgical procedures to prevent the recurrence of infections in the skin. Intravenous immunoglobulin is given as intravenous infusions. It will restrict the damages caused by the antibodies on the skin and muscles. This procedure is way too expensive and might require repeated infusions.

  • Lifestyle Modifications: Proper counseling is given to the patient to educate them about the illness and methods to cope with it. Continue your regular follow-ups with your doctor. Do not involve in too much physical work. Sunscreen lotions are known to be the best to prevent the damages caused by the sun. It will restrict the sun's rays and will prevent the sensitivity of the skin. It is also advised to wear appropriate and protective clothes.

Frequently Asked Questions

1.

How Does Dermatomyositis Appear?

A violet-colored or dusky red rash appears on the face and eyelids, as well as the knuckles, elbows, knees, chest, and back. Dermatomyositis frequently presents with a rash that can be itchy and painful as its initial symptom.

2.

Which Organs Are Affected By Dermatomyositis?

Inflammation of the heart muscles may be brought on by dermatomyositis. Congestive heart failure and issues with heart rhythm can appear in a limited number of patients with dermatomyositis. Dermatomyositis may accompany interstitial lung disease.

3.

Is There A Treatment For Dermatomyositis?

Dermatomyositis has no known treatment, but there are times when symptoms do get better. The skin rash can be cleared with treatment, and you can regain muscle function and strength.

4.

Is There A Treatment For Dermatomyositis?

For some individuals, dermatomyositis may spontaneously clear independently after five years following diagnosis. In few patients may experience symptoms that persist forever. Periodic guidance and assistance to help you manage symptoms and enhance your quality of life.

5.

Who Is Most Commonly Affected By Dermatomyositis?

Scientists believe it is caused by a viral infection of the muscles or a disturbance in the immune system. It can also happen to patients with cancer in their abdomen, lungs, or other areas. This disease can affect anyone. It most commonly affects children aged 5 to 15 and adults aged 40 to 60. Diabetes affects women two to three times more frequently than men (Marvi et al., 2012). Besides, women are generally more prone to autoimmune illnesses (Angum et al., 2020).

6.

What Blood Test Helps To Predict Dermatomyositis?

As soon as the physician suspects myositis, he would generally request a blood test to evaluate the number of muscle enzymes, such as 
- Creatine kinase (CK) an enzyme that leaks out of muscle fibers when the fibers are damaged, is aldolase. 
- Lactate dehydrogenase (LDH).
- Aspartate aminotransferase (AST). 
- Alanine aminotransferase (ALT) should be tested in suspected dermatomyositis (ALT) cases after a comprehensive history and physical exam to describe the patterns of weakness.

7.

How Much Time Does It Take To Heal Dermatomyositis?

Dermatomyositis cures itself in some patients roughly five years after diagnosis. In certain cases, symptoms may persist for a lifetime.

8.

What Types Of Cancer Induces Dermatomyositis?

Dermatomyositis has been linked to various malignancies, including breast, ovarian, lung, and hematologic cancers, and as well as nasopharyngeal cancer, among Asian populations.

9.

Can An MRI Help To Identify Dermatomyositis?

Magnetic resonance imaging is the preferred modality for diagnosing and surveillance dermatomyositis involving muscles, fasciae, and the subcutis. It can detect diffusely hyperintense T2-weighted signals in acute inflammatory edematous changes in damaged muscles, fatty replacement, and atrophy.

10.

Which Conditions Mimic Dermatomyositis?

Several skin disorders, such as psoriasis, eczema, and verrucae vulgaris, Lyme disease can resemble dermatomyositis's unique Gottron's papules, and allergies can resemble the heliotrope rash.

11.

Does COVID Infection Aggrevate Dermatomyositis?

Regardless of whether the infection is minimal, COVID-19 causes aggravation of dermatomyositis. In such circumstances, extensive therapy should be explored. Until now, the prognosis has often been positive.

12.

Does The Sun Worsen Dermatomyositis?

Physicians recommend individuals with dermatomyositis avoid exposure to direct sunlight, which is the most prevalent cause of skin problems. Many people with the illness are photosensitive, which means they are more likely to develop a rash or have an existing rash worsen when exposed to ultraviolet (UV) rays.

13.

Is Dermatomyositis Painful?

Dermatomyositis refers to a collection of uncommon conditions. Muscle weakness, discomfort, or pain are the most common symptoms. This generally worsens gradually over time.

14.

What Supplements Are Helpful For Dermatomyositis?

People with dermatomyositis must give the body the proper quantity of macronutrients and trace elements to maintain and improve physiological functioning. Calcium and vitamin D supplementation are beneficial.

15.

Does Exercise Helps Dermatomyositis?

Dermatomyositis has no treatment, although the symptoms can be managed with medicine, physical therapy, exercise, heat treatment, and rest. Corticosteroids, immunosuppressant agents, and topical lotions are examples of medications.
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Dr. Barve Vaibhav Saidas
Dr. Barve Vaibhav Saidas

Dermatology

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