What is Dermatomyositis?
This is a muscle disease. It is a rare type of inflammatory myopathy, which is a term that is used to describe neuromuscular diseases that are characterized by muscle weakness. It is a disease that can occur at any age but is most often seen in adults between the ages of forty and sixty. If a child has dermatomyositis it will usually occur between the ages of five and fifteen. In comparison between men and women, it seems that women are more prone to have it
There are two principle symptoms that are seen in people with dermatomyositis but there are also other minor symptoms a person can have. Typically these symptoms worsen over time.
The two principle symptoms are:
Dusky red or violet rash
These rashes are observed on the eyelids, elbows, chest, back, and knees, knuckles, face, and around your nails. It has also been known to develop on your scalp, back, and upper chest. In severe cases you can have blisters form along with this rash. The rash has a bluish-purple color. This rash is most often the first symptom of this medical condition.
Muscle weakness that is progressive
The second most important symptom is the muscle weakness that affects the muscles that are closest to your chest. Some of the muscles that can be affected include your thighs, upper arms, hips, shoulders, and neck. It first begins in your hip and shoulder muscles and as it progresses it can affect other muscles in your body. With time the symmetrical and proximal weakness will gradually worsen. This symptom can show up months, even years after you have the rash. Many times this weakness will be accompanied by muscle tenderness or pain in certain areas.
If you have the rash for at least six months or longer and do not experience muscle weakness it is clinically labeled amyopatic dermatomyositis.
Other more serious symptoms a person might have include:
- Being short of breath and other lung problems
- Having difficulty in swallowing
- Lifting objects become difficult
- Muscle pain and tenderness
- Having thinning hair or scaly scalp
- Climbing stairs become difficult.
- Seeing purple spots on your bony prominence.
- Getting gastrointestinal infections and ulcers, which is more commonly seen in children
- Weight loss
Approximately twelve to thirty-six months after you first develop dermatomyositis you may have calcium deposits that are under your skin start to develop and is called calcinosis. These calcium deposits are mostly seen in children than adults. These calcium deposits are hard bumps that can happen anywhere on the body but are most often found on the arms and hands.
The exact cause of dermatomyositis is not known but experts think it could be caused by a problem in your body’s immune system. It is also thought that it could be caused by a viral infection of your muscles.
When you visit your physician he will do a physical exam and take your medical history. Looking at the symptoms you have and the rash on your skin will help him make the correct diagnosis. Your physician may also perform tests to help with the diagnosis. Some of the tests can include:
With this type of test a scanner will create cross-sectional images of your muscles so the physician can get a better look at your muscles.
This test involves inserting a thin needle electrode into the muscle to be tested through your skin and is only done by a physician trained to do this highly specialized testing. As you tighten your muscle or relax them the electrical activity is measured and the changes that are seen in the electrical activity pattern can confirm if you have a muscle disease. This can also help the physician to determine the distribution of dermatomyositis by testing different muscles.
They will remove a little piece of your muscle tissue surgically to analyze by the laboratory. This test can reveal if there is inflammation in your muscles and will also be examined to see if you have any enzyme deficiencies or if there are abnormal proteins presence.
Doing a blood test will let your physician know if you have any elevated levels of muscle enzymes which can indicate you have muscle damage. This test can also detect if there are any specific auto antibodies that are associated with the different symptoms of dermatomyositis. This can help in determining the best treatment and medication to use.
When a small piece of skin is analyses it can help to confirm the diagnosis of this muscle disease. Usually the skin biopsy is done first because if a diagnosis is made with the skin biopsy then doing a muscle biopsy may not be necessary.
There is no cure for dermatomyositis but there are treatments that may help to strengthen your muscles along with increasing their function. You may also notice improvement in your skin. The medication that is used for treatments include corticosteroids which suppress your immune system. When this happens there is a decrease in the production of antibodies reducing the muscle and skin inflammation. The medication that is usually prescribed is prednisone. Taking corticosteroids is normally the first treatment the physician uses.
If the corticosteroids treatment does not work or to help decrease the side effects of corticosteroid your physician may prescribe corticosteroids-sparing agents. Your physician may prescribe methotrexate or azathioprine in combination with corticosteroids or by themselves. For the persistent rash you may be given a prescription for chloroquine or hydroxychloroquine, which are antimalarial medications.
In order to help build up your muscle strength you need to continue exercising. Your physician will start your on an exercise program and give you the names of the suitable exercises you are to do. Your physician may also recommend that you use physical therapy, which can also help to improve your strength and flexibility. If you are having trouble with swallowing or talking because your throat muscles are weakened your physician may suggest that you also have speech therapy.
For the pain that you may have with dermatomyositis you can take over-the-counter pain relievers but if the pain becomes extreme and chronic you can talk to your physician and see if you can get a prescription for a stronger pain reliever. You will also make sure that you are not overexerting yourself and getting plenty of rest. When you go outdoors you need to make sure that you are wearing protective clothing and sunscreen to help avoid skin sensitivity.
Even though there is not a cure for this rare inflammatory disease if you follow your doctor’s plan of treatment and get plenty of support from family and friends. Have a positive outlook on life. You can control this medical condition and not let it control you. Some patients even experience periods of remission where their symptoms improve spontaneously.