The management of dermatomyositis: current treatment options

Dermatomyositis is traditionally classified as one of the idiopathic inflammatory myopathies. The traditional approach to the management of patients with dermatomyositis focuses predominantly on end points related to the systemic manifestations of this disorder, especially proximal muscle weakness resulting from myositis. However, the primary and secondary skin changes that are characteristic of dermatomyositis can, in themselves, produce significant morbidity and disability. This article presents a dermatological perspective on the management of dermatomyositis. As dermatological management approaches can vary between countries, an effort has been made to present a consensus dermatological view concerning this subject. A US dermatologist is most likely to see patients having dermatomyositis skin lesions in the following four clinical settings: soon after the onset of dermatomyositis skin disease activity before the appearance of clinically-evident muscle disease (i.e., 'pre-myopathic' dermatomyositis); during the course of clinically-amyopathic dermatomyositis; during co-management of classical dermatomyositis with other physicians; and for recrudescent skin disease activity in classical dermatomyositis patients after their symptomatic muscle inflammation has been fully suppressed by systematic immunosuppressive/immunomodulatory treatment (i.e., 'postmyopathic' dermatomyositis). Both topical and systemic therapies for dermatomyositis skin lesions encountered in these various settings will be discussed. In addition to specific approaches to the treatment of dermatomyositis skin lesions, broader management issues that dermatologists must be aware of when caring for dermatomyositis patients are included in this discussion (e.g., patient education, risk of associated systemic disease, such as myositis and interstitial lung disease, risk for occult malignancy, and prognosis counselling).