Dr. Harp began her presentation by discussing skin changes that can occur in dermatomyositis (DM). These include:
Dr. Harp went on to explain that in DM, inflammation occurs where the dermal and epidermal layers of the skin meet. DM is an inflammatory myopathy (disease of the muscle tissue) with specific and non-specific skin lesions described above. Skin disease often develops before muscle disease; Dr. Harp recommended that all people with DM who have skin lesions should be evaluated for muscle and lung disease, and undergo cancer screenings, even if no other symptoms are present. It is thought that the risk for developing cancer is increased for 3 years after DM diagnosis, and potentially for up to 5 years. Dr. Harp stated that, since ovarian cancer is over-represented in women with DM, she would recommend transvaginal ultrasound or other imaging for her patients with the condition. Some patients may opt for additional screening in consultation with their primary care physician/rheumatologist.
Other types of dermatomyositis include:
Dr. Harp presented various skin-focused treatments. She emphasized the importance of topical (external) treatments and protection from the sun.
Topical treatment can include steroids applied to the affected areas. When used correctly, the risk of side effects is low. Depending on the part of the body that is being treated, different strengths of steroids may be used. In addition, different areas of the body require different forms of treatment. Ointments, which are Vaseline-based tend to be stronger than creams.
As an example, Dr. Harp described the treatment of a 56-year-old patient with dermatomyositis, with involvement of the scalp, eyelid, and chest, as well as hand rash, in which each area that was affected was treated with different types and strengths of topical agents. It is important to note that each individual requires different treatment and that this is best discussed with your doctor.
Dr. Harp noted that itching can be a debilitating effect of DM. Patients experiencing this symptom should speak with their doctor, who may recommend oral and/or topical options for treatment.
Individuals who do not achieve symptom relief with topical treatment should consult their doctor. He or she may consider prescribing antimalarials, such as Plaquenil (hydroxychloroquine). According to Dr. Harp this class of drugs helps 40-75% of people with DM.
Dr. Harp stated that antimalarials have UV (ultraviolet) protective benefits and are not immunosuppressives. There is a rare risk of a flare of DM symptoms, but the benefit may outweigh the risk.
Owing to a risk of side effects that affect vision, an eye exam is recommended before starting antimalarials and then yearly after 5 years of initiating treatment.
Dr. Harp also described treatment options that may be used when skin disease is more severe. These include:
Learn more about the HSS Myositis Support Group, a free support and education group, held monthly for people with myositis and their family and friends.
1. How to Select a Sunscreen, American Academy of Dermatology
Summary by Suzan Fischbein, LCSW, Social Work Coordinator, Myositis Support Group
Edited by Nancy Novick