Dermatomyositis is an inflammatory disease characterized by muscle weakness, skin rash, and muscle inflammation. This rare condition can affect children and adults.
In dermatomyositis, most of the inflammation occurs in the small blood vessels in the muscle tissue. This condition causes damage to healthy muscle fibers. If the rash does not appear but occurs in the muscles on both sides of the body, then this autoimmune disease is called polymyositis .
Causes of Dermatomyositis
It is not yet known what causes dermatomyositis. However, this condition is suspected to be related to autoimmune disease , which is a condition when the body's immune system instead attacks healthy body tissue and causes inflammation.
Risk factors for dermatomyositis
Dermatomyositis can happen to anyone, but more often affects women than men. Dermatomyositis is also more often experienced by adults aged 40-60 years and children aged 5-15 years.
Although often associated with autoimmune diseases, dermatomyositis is also more at risk for patients with viral infections or cancer . This is suspected to be related to the immune system being active when a person is infected with a virus or cancer.
Symptoms of Dermatomyositis
Symptoms of dermatomyositis can appear suddenly or develop gradually over weeks or months. Symptoms include:
- A reddish or bluish rash on the face, eyelids, back, chest, knuckles, elbows, and knees, accompanied by itching and pain
- Muscle weakness around the neck, shoulders, thighs, or hips, which can worsen over time
- Hard lumps ( calcinosis ) under the skin of knuckles, elbows, knees, and ankles
- Reddish spots ( Gottron papules ) that stand out on the joints of fingers and toes, elbows, or knees
- It is easy to get tired or faint even if you just go up and down the stairs, get up from sitting, or raise your arms
- Scaly scalp with hair loss
- Difficulty swallowing ( dysphagia )
- Sudden weight loss
- Sensitive to light
- Lung disorders
- Shortness of breath
- Fever
When should you go to the doctor?
Immediately see a doctor if you experience muscle weakness accompanied by the appearance of a rash on the skin. Treatment given early will be more effective in restoring the strength and function of the patient's muscles.
Diagnosis of Dermatomyositis
The doctor will ask about the patient's symptoms and health history, followed by a physical examination. Further, to confirm the diagnosis, the doctor will perform the following supporting examinations:
- Blood test , to detect increased levels of muscle enzymes, such as creatine kinase (CK) and aldolase which can be a sign of muscle damage, as well as detect the presence of antinuclear antibody (ANA)
- Chest X -ray , to detect lung damage that sometimes occurs in patients with dermatomyositis
- MRI scan , to see inflammation in the muscles using radio waves and magnetic fields
- Electromyography (EMG), to measure electrical activity in the muscles
- Skin or muscle biopsy , to look for inflammation in the muscle by taking a tissue sample from the skin or muscle and examining it in a laboratory
Treatment of Dermatomyositis
Treatment of dermatomyositis aims to relieve symptoms and reduce the risk of complications. The treatment method is by giving drugs, therapy, or surgery. Here is the explanation:
Medicines
The types of drugs that can be prescribed by doctors for patients with dermatomyositis include:
- Corticosteroids, such as prednisone , to reduce inflammation due to the body's immune system response
- Corticosteroid-sparing agents , such as azathioprine or methotrexate used in conjunction with corticosteroids, to suppress the possible side effects of corticosteroids
- Rituximab , to relieve symptoms if initial therapy fails
- Antimalarial drugs , such as hydroxychloroquine , to treat skin rashes that do not go away
- Intravenous immunoglobulin (IVIG), to inhibit the work of abnormal antibodies by inserting healthy antibodies into the blood vessels
Therapy
There are several therapies that can be done to ease the symptoms of dermatomyositis. These therapies include:
- Physical therapy or physiotherapy , to restore and improve muscle strength and flexibility
- Speech therapy , to overcome speech difficulties due to disturbances in the muscles in the face and larynx
- Eating pattern therapy, to overcome chewing and swallowing disorders
In patients with dermatomyositis who suffer from calcinosis , the doctor will perform an operation to remove the accumulation of calcium in the patient's body to avoid further skin infection.
To help the treatment process, the doctor will advise the patient to use sunscreen and closed clothing when being active outdoors, especially during the day.
Complications of Dermatomyositis
Some of the complications that can occur due to dermatomyositis are:
- Aspiration pneumonia
- Difficulty breathing
- Accumulation of calcium in muscles, skin, and body tissues (calcinosis)
- Stomach ulcer
- Difficulty eating due to dysphagia
- Malnutrition
- Weight loss
In addition to a number of complications above, dermatomyositis can also increase the risk of sufferers experiencing other conditions, such as:
- Raynaud's phenomenon , which is a condition that causes fingers and toes, cheeks, nose, and ears to look pale when exposed to cold temperatures
- Connective tissue diseases, such as lupus , rheumatoid arthritis , scleroderma, or Sjögren's syndrome
- Heart disease, such as myocarditis , heart rhythm disorders ( arrhythmias ), or heart failure
- Cancer, especially cancer of the cervix, lung, pancreas, breast, ovary, or digestive tract
- Interstitial lung disease , which is a group of diseases caused by disorders of the connective tissue in the lungs
Prevention of Dermatomyositis
As explained above, the cause of dermatomyositis is still unknown. Therefore, it is not known how to prevent this disease. However, treatment done as soon as possible can prevent dermatomyositis from getting worse.