Dermatomyositis, Causes, Diagnosis, Treatment, Prevention, Complications

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Dermatomyositis is an inflammatory disease characterized by muscle weakness, skin rashes and inflammation of the muscles. This rare condition can affect both children and adults. In dermatomyositis, most of the inflammation occurs in the small blood vessels in the muscle tissue. This condition causes damage to healthy muscle fibers. If there is no rash but occurs in the muscles on both sides of the body, then this autoimmune disease is called polymyositis.

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Dermatomyositis, Causes, Diagnosis, Treatment, Prevention, Complications

Causes of Dermatomyositis


It is not known what causes dermatomyositis. However, this condition is thought to be related to autoimmune disease, which is a condition in which the body's immune system instead attacks healthy body tissue and causes inflammation.

Risk factors for dermatomyositis

Dermatomyositis can happen to anyone, but it affects women more often than men. Dermatomyositis is also more common in adults aged 40–60 years and children aged 5–15 years.

Although often associated with autoimmune diseases, dermatomyositis is also more at risk for sufferers of viral infections or cancer. This is thought to be related to the immune system being active when a person has a viral infection or cancer.

Symptoms of Dermatomyositis


The symptoms of dermatomyositis can appear suddenly or develop gradually over weeks or months. Symptoms include:

  • Red or bluish rash on the face, eyelids, back, chest, knuckles, elbows, and knees, which is accompanied by itching and pain
  • Weak muscles around the neck, shoulders, thighs, or hips, which may get worse over time
  • Hard lumps (calcinosis) under the skin of the knuckles, elbows, knees and ankles
  • Reddish spots (Gottron papules) that stand out on the joints of the fingers and toes, elbows or knees
  • Easily tired or weak even if you just go up and down stairs, get up from sitting, or raise your arms
  • Scaly scalp accompanied by hair loss
  • Difficulty swallowing (dysphagia)
  • Sudden weight loss
  • Sensitive to light
  • Lung disorders
  • Hard to breathe
  • Fever


When to see a doctor

Immediately to the doctor if you experience muscle weakness accompanied by the appearance of rashes on the skin. Treatment given early will be more effective in restoring the patient's muscle strength and function.

Diagnosis of Dermatomyositis


The doctor will ask about the patient's symptoms and medical history, followed by a physical examination. Furthermore, to confirm the diagnosis, the doctor will carry out the following supporting examinations:

  • Blood tests, to detect elevated levels of muscle enzymes, such as creatine kinase (CK) and aldolase which can be a sign of muscle damage, as well as detect the presence of antinuclear antibodies (ANA)
  • Chest X-ray, to detect damage to the lungs which sometimes occurs in people with dermatomyositis
  • MRI scan, to see inflammation in the muscles using radio waves and a magnetic field
  • Electromyography (EMG), to measure electrical activity in the muscles
  • Skin or muscle biopsy, to look for inflammation in the muscles by taking tissue samples in the skin or muscles and examining them in the laboratory


Treatment of Dermatomyositis


Treatment of dermatomyositis aims to relieve symptoms and reduce the risk of complications. The method of treatment is by administering drugs, therapy, or surgery. The following is an explanation:

Drugs

Types of drugs that doctors can prescribe for dermatomyositis patients include:

  • Corticosteroids, such as prednisone, to reduce inflammation due to immune system response
  • Corticosteroid-sparing agents, such as azathioprine or methotrexate are used together with corticosteroids, to reduce the possible side effects of corticosteroids
  • Rituximab, for symptomatic relief if initial therapy fails
  • Antimalarial drugs, such as hydroxychloroquine, to treat skin rashes that don't go away
  • Intravenous immunoglobulin (IVIG), to inhibit the work of abnormal antibodies by introducing healthy antibodies into the blood vessels


Therapy

There are several therapies that can be done to relieve the symptoms of dermatomyositis. These therapies include:

  • Physical therapy or physiotherapy, to restore and improve muscle strength and flexibility
  • Speech therapy, to treat speech difficulties due to disorders of the muscles in the face and larynx
  • Diet control therapy, to overcome chewing and swallowing disorders


In dermatomyositis patients who have calcinosis, the doctor will perform surgery to remove calcium buildup in the patient's body to avoid further skin infections.

To help with the treatment process, doctors will advise patients to use sunscreen and closed clothing when doing outdoor activities, especially during the day.

Dermatomyositis complications


Some of the complications that can occur due to dermatomyositis are:

  • Aspiration pneumonia
  • Difficulty breathing
  • Calcium buildup in muscles, skin, and body tissues (calcinosis)
  • gastric ulcer
  • Difficulty eating due to dysphagia
  • Malnutrition
  • Weight loss


Apart from the complications above, dermatomyositis can also increase the risk of sufferers experiencing other conditions, such as:

  • Raynaud's phenomenon, which is a condition that causes the fingers and toes, cheeks, nose, and ears to look pale when exposed to cold temperatures
  • Connective tissue diseases, such as lupus, rheumatoid arthritis, scleroderma, or Sj√∂gren's syndrome
  • Heart disease, such as myocarditis, heart rhythm disturbances (arrhythmias), or heart failure
  • Cancer, especially cancer of the cervix, lung, pancreas, breast, ovary or digestive tract
  • Interstitial lung disease, which is a group of diseases caused by disorders of the connective tissue in the lungs


Prevention of Dermatomyositis


As explained above, the cause of dermatomyositis is still unknown. Therefore, it is not known how to prevent this disease. However, treatment as soon as possible can prevent dermatomyositis from getting worse.

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