eMedicine Specialties > Dermatology > Connective Tissue Diseases

Eosinophilia-Myalgia Syndrome: Treatment & Medication

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Nicole Quartarolo, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School; Vinay Arya, MD, Staff Physician, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine
Contributor Information and Disclosures

Updated: May 21, 2008

Treatment

Medical Care

  • The most important component of treatment is to discontinue the use of any product containing L-tryptophan.
  • The mainstay of pharmacologic treatment is glucocorticoid therapy, which benefits many patients but is not effective for all symptoms of EMS.
  • Other care depends on the manifestations of the disease. In many cases, it is mostly supportive.

Consultations

Because of the high morbidity associated with EMS, referral to mental health experts should be obtained.

  • Psychotherapy may be helpful in dealing with alterations in mood and behavior secondary to the acquired disabilities.
  • Furthermore, psychological evaluation may provide techniques to use in dealing with compromised function for patients who are affected.

Medication

Glucocorticoids appear to benefit most patients with EMS, but many symptoms do not respond to this treatment. Usually, eosinophilia markedly decreases, and edema and pulmonary infiltrates resolve in response to glucocorticoids. Nonsteroidal anti-inflammatory agents and narcotic analgesics may be useful for the relief of severe muscle pain.

Glucocorticoids

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.


Prednisone (Deltasone, Orasone, Meticorten)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocyte and antibody production.

Adult

5-60 mg PO qd or divided bid/qid; taper over 2 wk as symptoms resolve

Pediatric

4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2 wk as symptoms resolve

Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; fungal, viral, connective tissue, and tubercular skin infections; peptic ulcer disease; GI disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use

More on Eosinophilia-Myalgia Syndrome

Overview: Eosinophilia-Myalgia Syndrome
Differential Diagnoses & Workup: Eosinophilia-Myalgia Syndrome
Treatment & Medication: Eosinophilia-Myalgia Syndrome
Follow-up: Eosinophilia-Myalgia Syndrome
References
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References

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Further Reading

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Keywords

EMS, L-tryptophan-induced eosinophilia-myalgia syndrome, sclerodermoid myalgia, sclerodermoid fasciitis, eosinophilia associated with ingestion of tryptophan, L-tryptophan

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Nicole Quartarolo, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School
Nicole Quartarolo, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi
Disclosure: Nothing to disclose.

Vinay Arya, MD, Staff Physician, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine
Vinay Arya, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Takeji Nishikawa, MD, Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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