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Treatments and drugs
By Mayo Clinic staffThere's no cure for dermatomyositis, but treatment can improve your skin and your muscle strength and function. The earlier treatment is started in the course of dermatomyositis, the more effective it is, leading to fewer complications.
Drugs
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Corticosteroids. These medications suppress your immune system, limiting the production of antibodies and reducing skin and muscle inflammation, as well as improving muscle strength and function. Corticosteroids, especially prednisone, are usually the first choice in treating inflammatory myopathies such as dermatomyositis.
Your doctor may start with a very high dose, and then decrease it as your signs and symptoms improve. Improvement generally takes about two to four weeks, but therapy is often needed for years. Your doctor may also prescribe topical corticosteroids for your skin.
Prolonged use of corticosteroids can have serious and wide-ranging side effects, so your doctor may recommend supplements to combat them, such as calcium and vitamin D, and may prescribe bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel) or zoledronic acid (Reclast). Bisphosphonates taken in pill form may not be recommended if you have difficulty swallowing.
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Corticosteroid-sparing agents. Your doctor may recommend other medications, either to decrease side effects or if your condition doesn't respond to corticosteroids. These medications include azathioprine (Imuran) or methotrexate (Rheumatrex). Your doctor may prescribe these alone or in combination with corticosteroids.
Immunosuppressants, such as cyclophosphamide (Cytoxan) and cyclosporine (Neoral, Sandimmune), also may improve signs and symptoms of dermatomyositis and interstitial lung disease.
- Antimalarial medications. For a persistent rash, your doctor may prescribe an antimalarial medication, such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen).
- Pain relievers. Over-the-counter drugs such as aspirin, ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), can be used to treat pain. If these aren't sufficient, your doctor may prescribe a stronger pain reliever, such as codeine.
Antibody therapy
- Intravenous immunoglobulin (IVIg). Immunoglobulin contains healthy antibodies from blood donors. High doses can block the damaging antibodies that attack muscle and skin in dermatomyositis.
Immunosuppressive therapies
In addition to corticosteroids and immunosuppressive drugs, other treatments to suppress your immune system include:
- Tacrolimus (Prograf). This transplant-rejection drug may work to inhibit the immune system. Tacrolimus is often used topically to treat dermatomyositis and other skin problems. When taken orally, it may be helpful if you have dermatomyositis complicated by interstitial lung disease.
Investigational treatment
- Biological therapies. Rituximab (Rituxan), which depletes a certain type of lymphocyte (B cells), has been studied in small numbers of people with polymyositis and dermatomyositis and shown to improve muscle strength, lung involvement and skin rash. Tumor necrosis factor (TNF) inhibitors such as etanercept (Enbrel) and infliximab (Remicade) have not been shown to be effective in trials with small numbers of people with polymyositis or dermatomyositis. Rituximab is not approved by the Food and Drug Administration for the treatment of dermatomyositis, so your insurance company will likely require preapproval if you wish to be reimbursed.
Therapies
- Physical therapy. A physical therapist can show you exercises to maintain and improve your strength and flexibility and advise an appropriate level of activity.
- Speech therapy. If your swallowing muscles are weakened by dermatomyositis, speech therapy can help you learn how to compensate for those changes.
- Dietetic assessment. Later in dermatomyositis, chewing and swallowing can become more difficult. A registered dietitian can teach you how to prepare easy-to-eat foods.
Other treatments
- Surgery. Surgery may be an option to remove painful calcium deposits and prevent recurrent skin infections.
- NINDS dermatomyositis information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dermatomyositis/dermatomyositis.htm. Accessed May 6, 2009.
- Baer A. Advances in the therapy of idiopathic inflammatory myopathies. Current Opinion in Rheumatology. 2006;18:236.
- Dalakas MC. Inflammatory disorders of muscle: Progress in polymyositis, dermatomyositis and inclusion body myositis. Current Opinion in Neurology. 2004;17:561.
- Miller ML. Clinical manifestations and diagnosis of adult dermatomyositis and polymyositis. http://www.uptodate.com/home/index.html. Accessed May 8, 2009.
- Greenberg SA, et al. Uncertainties in the pathogenesis of adult dermatomyositis. Current Opinion in Neurology. 2004;17:359.
- Santmyire-Rosenberger B, et al. Skin involvement in dermatomyositis. Current Opinion in Rheumatology. 2003;15:714.
- Amato AA, et al. Treatment of idiopathic inflammatory myopathies. Current Opinion in Neurology. 2003;16:569.
- Oddis CV. Current approach to the treatment of polymyositis and dermatomyositis. Current Opinion in Rheumatology. 2000;12:492.
- Walker UA. Imaging tools for the clinical assessment of idiopathic inflammatory myositis. Current Opinion in Rheumatology. 2008;20:656.
- Miller ML, et al. Initial treatment of dermatomyositis and polymyositis in adults. http://www.uptodate.com/home/index.html. Accessed May 8, 2009.
- Miller ML, et al. Treatment of recurrent and resistant polymyositis and dermatomyositis. http://www.uptodate.com/home/index.html. Accessed June 15, 2009.
