eMedicine Specialties > Rheumatology > Systemic Rheumatic Disease

Dermatomyositis: Multimedia

Author: Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: Apr 14, 2009

Multimedia

The heliotrope flower from which the manifestatio...Media file 1: The heliotrope flower from which the manifestation of dermatomyositis is named.
The heliotrope flower from which the manifestatio...

The heliotrope flower from which the manifestation of dermatomyositis is named.

Heliotrope rash in a woman with dermatomyositis.Media file 2: Heliotrope rash in a woman with dermatomyositis.
Heliotrope rash in a woman with dermatomyositis.

Heliotrope rash in a woman with dermatomyositis.

Gottron papules and nailfold telangiectasia are p...Media file 3: Gottron papules and nailfold telangiectasia are present in this patient with dermatomyositis.
Gottron papules and nailfold telangiectasia are p...

Gottron papules and nailfold telangiectasia are present in this patient with dermatomyositis.

These lesions on the dorsal hands demonstrate the...Media file 4: These lesions on the dorsal hands demonstrate the photodistribution of dermatomyositis. Note the sparing of the interdigital web spaces.
These lesions on the dorsal hands demonstrate the...

These lesions on the dorsal hands demonstrate the photodistribution of dermatomyositis. Note the sparing of the interdigital web spaces.

A diffuse alopecia with a scaly scalp dermatosis ...Media file 5: A diffuse alopecia with a scaly scalp dermatosis is common in patients with dermatomyositis.
A diffuse alopecia with a scaly scalp dermatosis ...

A diffuse alopecia with a scaly scalp dermatosis is common in patients with dermatomyositis.

Dermatomyositis is often associated with a poikil...Media file 6: Dermatomyositis is often associated with a poikiloderma in a photodistribution.
Dermatomyositis is often associated with a poikil...

Dermatomyositis is often associated with a poikiloderma in a photodistribution.

The histopathology of dermatomyositis is an inter...Media file 7: The histopathology of dermatomyositis is an interface dermatitis.
The histopathology of dermatomyositis is an inter...

The histopathology of dermatomyositis is an interface dermatitis.

Calcinosis caused by dermatomyositis (DM) in chil...Media file 8: Calcinosis caused by dermatomyositis (DM) in childhood can be observed in a patient who had active DM 15 years before the time of this photograph.
Calcinosis caused by dermatomyositis (DM) in chil...

Calcinosis caused by dermatomyositis (DM) in childhood can be observed in a patient who had active DM 15 years before the time of this photograph.

Histopathology of dermatomyositis showing inflamm...Media file 9: Histopathology of dermatomyositis showing inflammatory myopathic changes with a predominantly perivascular chronic inflammatory infiltrate.
Histopathology of dermatomyositis showing inflamm...

Histopathology of dermatomyositis showing inflammatory myopathic changes with a predominantly perivascular chronic inflammatory infiltrate.

More on Dermatomyositis

Overview: Dermatomyositis
Differential Diagnoses & Workup: Dermatomyositis
Treatment & Medication: Dermatomyositis
Follow-up: Dermatomyositis
Multimedia: Dermatomyositis
References
Further Reading

References

  1. Bohan A, Peter JB. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. Feb 20 1975;292(8):403-7. [Medline].

  2. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. Feb 13 1975;292(7):344-7. [Medline].

  3. Levine TD. Rituximab in the treatment of dermatomyositis: an open-label pilot study. Arthritis Rheum. 2005;52:601-7. [Medline].

  4. Chung L, Genovese MC, Fiorentino DF. A pilot trial of rituximab in the treatment of patients with dermatomyositis. Arch Dermatol. Jun 2007;143(6):763-7. [Medline].

  5. Werth VP, Callen JP, Ang G, Sullivan KE. Associations of tumor necrosis factor alpha and HLA polymorphisms with adult dermatomyositis: implications for a unique pathogenesis. J Invest Dermatol. Sep 2002;119(3):617-20. [Medline].

  6. O'Hanlon T, Koneru B, Bayat E, Love L, Targoff I, Malley J. Immunogenetic differences between Caucasian women with and those without silicone implants in whom myositis develops. Arthritis Rheum. Nov 2004;50(11):3646-50. [Medline].

  7. Pelle MT, Callen JP. Adverse cutaneous reactions to hydroxychloroquine are more common in patients with dermatomyositis than in patients with cutaneous lupus erythematosus. Arch Dermatol. Sep 2002;138(9):1231-3; discussion 1233. [Medline].

  8. Woo TY, Callen JP, Voorhees JJ, et al. Cutaneous lesions of dermatomyositis are improved by hydroxychloroquine. J Am Acad Dermatol. Apr 1984;10(4):592-600. [Medline].

  9. Edge JC, Outland JD, Dempsey JR, Callen JP. Mycophenolate mofetil as an effective corticosteroid-sparing therapy for recalcitrant dermatomyositis. Arch Dermatol. Jan 2006;142(1):65-9. [Medline].

  10. Majithia V, Harisdangkul V. Mycophenolate mofetil (CellCept): an alternative therapy for autoimmune inflammatory myopathy. Rheumatology (Oxford). Mar 2005;44(3):386-9. [Medline].

  11. Pisoni CN, Cuadrado MJ, Khamashta MA, Hughes GR, D'Cruz DP. Mycophenolate mofetil treatment in resistant myositis. Rheumatology (Oxford). Mar 2007;46(3):516-8. [Medline].

  12. Rowin J, Amato AA, Deisher N, Cursio J, Meriggioli MN. Mycophenolate mofetil in dermatomyositis: is it safe?. Neurology. Apr 25 2006;66(8):1245-7. [Medline].

  13. Waldman MA, Callen JP. Self-resolution of Epstein-Barr virus-associated B-cell lymphoma in a patient with dermatomyositis following withdrawal of mycophenolate mofetil and methotrexate. J Am Acad Dermatol. Aug 2004;51(2 Suppl):S124-30. [Medline].

  14. Nadiminti U, Arbiser JL. Rapamycin (sirolimus) as a steroid-sparing agent in dermatomyositis. J Am Acad Dermatol. Feb 2005;52(2 Suppl 1):17-9. [Medline].

  15. Boswell JS, Costner MI. Leflunomide as adjuvant treatment of dermatomyositis. J Am Acad Dermatol. Mar 2008;58(3):403-6. [Medline].

  16. Oliveri MB, Palermo R, Mautalen C, Hubscher O. Regression of calcinosis during diltiazem treatment in juvenile dermatomyositis. J Rheumatol. Dec 1996;23(12):2152-5. [Medline].

  17. Hill CL, Zhang Y, Sigurgeirsson B, et al. Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet. Jan 13 2001;357(9250):96-100. [Medline].

  18. Callen JP, Wortmann RL. Dermatomyositis. Clin Dermatol. Sep-Oct 2006;24(5):363-73. [Medline].

  19. Iorizzo LJ 3rd, Jorizzo JL. The treatment and prognosis of dermatomyositis: an updated review. J Am Acad Dermatol. Jul 2008;59(1):99-112. [Medline].

  20. Krathen MS, Fiorentino D, Werth VP. Dermatomyositis. Curr Dir Autoimmun. 2008;10:313-32. [Medline].

  21. Airio A, Pukkala E, Isomaki H. Elevated cancer incidence in patients with dermatomyositis: a population based study. J Rheumatol. Jul 1995;22(7):1300-3. [Medline].

  22. Callen JP. Dermatomyositis. Lancet. Jan 1 2000;355(9197):53-7. [Medline].

  23. Callen JP. Relation between dermatomyositis and polymyositis and cancer. Lancet. Jan 13 2001;357(9250):85-6. [Medline].

  24. Callen JP. The value of malignancy evaluation in patients with dermatomyositis. J Am Acad Dermatol. Feb 1982;6(2):253-9. [Medline].

  25. Callen JP. When and how should the patient with dermatomyositis or amyopathic dermatomyositis be assessed for possible cancer?. Arch Dermatol. Jul 2002;138(7):969-71. [Medline].

  26. Chow WH, Gridley G, Mellemkjaer L, et al. Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control. Jan 1995;6(1):9-13. [Medline].

  27. Dalakas MC. Molecular immunology and genetics of inflammatory muscle diseases. Arch Neurol. Dec 1998;55(12):1509-12. [Medline].

  28. Dalakas MC, Illa I, Dambrosia JM, et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med. Dec 30 1993;329(27):1993-2000. [Medline].

  29. Daoud MS, Gibson LE, Pittelkow MR. Hydroxyurea dermopathy: a unique lichenoid eruption complicating long-term therapy with hydroxyurea. J Am Acad Dermatol. Feb 1997;36(2 Pt 1):178-82. [Medline].

  30. Efthimiou P. Tumor necrosis factor-alpha in inflammatory myopathies: pathophysiology and therapeutic implications. Semin Arthritis Rheum. Dec 2006;36(3):168-72. [Medline].

  31. el-Azhary RA, Pakzad SY. Amyopathic dermatomyositis: retrospective review of 37 cases. J Am Acad Dermatol. 2002;46:560-5. [Medline].

  32. Euwer RL, Sontheimer RD. Amyopathic dermatomyositis (dermatomyositis sine myositis). Presentation of six new cases and review of the literature. J Am Acad Dermatol. Jun 1991;24(6 Pt 1):959-66. [Medline].

  33. Fujisawa T, Suda T, Nakamura Y, et al. Differences in clinical features and prognosis of interstitial lung diseases between polymyositis and dermatomyositis. J Rheumatol. Jan 2005;32(1):58-64. [Medline].

  34. Gerami P, Walling HW, Lewis J, Doughty L, Sontheimer RD. A systematic review of juvenile-onset clinically amyopathic dermatomyositis. Br J Dermatol. Oct 2007;157(4):637-44. [Medline].

  35. Hengstman GJ, De Bleecker JL, Feist E, Vissing J, Denton CP, Manoussakis MN, et al. Open-label trial of anti-TNF-alpha in dermato- and polymyositis treated concomitantly with methotrexate. Eur Neurol. 2008;59(3-4):159-63. [Medline].

  36. Hengstman GJ, van den Hoogen FH, van Engelen BG. Treatment of dermatomyositis and polymyositis with anti-tumor necrosis factor-alpha: long-term follow-up. Eur Neurol. 2004;52(1):61-3. [Medline].

  37. Kasteler JS, Callen JP. Low-dose methotrexate administered weekly is an effective corticosteroid-sparing agent for the treatment of the cutaneous manifestations of dermatomyositis. J Am Acad Dermatol. Jan 1997;36(1):67-71. [Medline].

  38. Kasteler JS, Callen JP. Scalp involvement in dermatomyositis. Often overlooked or misdiagnosed. JAMA. Dec 28 1994;272(24):1939-41. [Medline].

  39. Marie I, Hatron PY, Levesque H, et al. Influence of age on characteristics of polymyositis and dermatomyositis in adults. Medicine (Baltimore). May 1999;78(3):139-47. [Medline].

  40. Mosca M, Strigini F, Carmignani A, et al. Pregnant patient with dermatomyositis successfully treated with intravenous immunoglobulin therapy. Arthritis Rheum. Feb 15 2005;53(1):119-21. [Medline].

  41. Sigurgeirsson B, Lindelof B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study. N Engl J Med. Feb 6 1992;326(6):363-7. [Medline].

  42. Sontheimer RD. Skin manifestations of systemic autoimmune connective tissue disease: diagnostics and therapeutics. Best Pract Res Clin Rheumatol. Jun 2004;18(3):429-62. [Medline].

  43. Sontheimer RD. The management of dermatomyositis: current treatment options. Expert Opin Pharmacother. May 2004;5(5):1083-99. [Medline].

  44. Targoff IN. Dermatomyositis and polymyositis. Curr Probl Dermatol. 1991;3:131-180.

  45. Villalba L, Hicks JE, Adams EM, et al. Treatment of refractory myositis: a randomized crossover study of two new cytotoxic regimens. Arthritis Rheum. Mar 1998;41(3):392-9. [Medline].

  46. Weinel S, Callen JP. Calcinosis cutis complicating adult-onset dermatomyositis. Arch Dermatol. 2004;140:365-6. [Medline].

  47. Wetter DA, Davis MD, Yiannias JA, et al. Effectiveness of intravenous immunoglobulin therapy for skin disease other than toxic epidermal necrolysis: a retrospective review of Mayo Clinic experience. Mayo Clin Proc. Jan 2005;80(1):41-7. [Medline].

  48. Whitmore SE, Rosenshein NB, Provost TT. Ovarian cancer in patients with dermatomyositis. Medicine (Baltimore). May 1994;73(3):153-60. [Medline].

  49. Yokoyama T, Sakamoto T, Shida N, et al. Fatal rapidly progressive interstitial pneumonitis associated with amyopathic dermatomyositis and CD8 T lymphocytes. J Intensive Care Med. May-Jun 2005;20(3):160-3. [Medline].

  50. Zieglschmid-Adams ME, Pandya AG, Cohen SB, Sontheimer RD. Treatment of dermatomyositis with methotrexate. J Am Acad Dermatol. May 1995;32(5 Pt 1):754-7. [Medline].

Further Reading

The reader is referred to articles by Callen and Wortmann (2006), 18 Iorizzo and Joizzo (2008), 19 and Krathen et al (2008) 20 for further reading.

Keywords

dermatomyositis, idiopathic inflammatory myopathy, IIM, dermatomyositis sine myositis, amyopathic dermatomyositis, ADM, juvenile dermatomyositis, childhood dermatomyositis, DM, polymyositis, PM, DM-sine myositis, myositis with malignancy, childhood DM, childhood PM, myositis, postmyopathic DM, postmyopathic dermatomyositis, complement-mediated vascular inflammation, terminal attack complex, calcinosis, heliotrope rash, Gottron papules

Contributor Information and Disclosures

Author

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

Medical Editor

Kristine M Lohr, MD, MS, Program Director, Professor, Department of Internal Medicine, Division of Rheumatology and Women's Health, University of Kentucky School of Medicine
Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and American Medical Women's Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Lawrence H Brent, MD, Associate Professor of Medicine, Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center
Lawrence H Brent, MD is a member of the following medical societies: American Association of Immunologists, American College of Physicians, and American College of Rheumatology
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Grant/research funds Other; Amgen Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Immunology Honoraria Speaking and teaching

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.