What is Dermatomyositis?
Dermatomyositis is a muscle disease under the group of diseases called as the inflammatory myopathies. The common manifestation is muscle swelling together with muscle weakness for a prolonged period of time. The main symptom of dermatomyositis is a rash on the skin that come first, goes together with, or goes after the development of muscle weakness. The rash is described as patchy, purple or red in color, usually seen on the eyelids, muscles especially those who are in close proximity to joints such as knuckles, knees, elbows, and toes. Rashes and sometimes swelling can also be seen on the face, neck, shoulders, chest, back, and other areas. Occasionally the skin rash happens with no apparent muscle participation. Adults suffering from this disease may manifest reduced weight, fever (low-grade), irritated lungs, and light sensitivity in which when there is light the rash will get even worse.
Both Children and adults may have calcinosis or in layman’s term calcium deposits. They come out as solid lumps underneath the skin or inside the muscle. Calcinosis usually begins one to three years after the onset of dermatomyositis. It is more often happen in children rather than adults. Several cases of dermatomyositis have reported that distal muscles like forearms, ankles and wrists can have skin rashes as the disease become more progressive. Dermatomyositis may be related with autoimmune diseases like lupus.
Dermatomyositis Signs and Symptoms
Usually the main signs and symptoms of dermatomyositis consist of:
Changes in the skin
- Patchy skin rash, purple or red in color
- The rashes are usually located on the face, eyelids, nails, knuckles, elbows, knees, chest and back
- The bluish and purplish skin rash is the initial sign of dermatomyositis
Weakness in the muscle
- usually affects the muscles near the trunk (hips, thighs, shoulders, upper arms and neck)
- symmetrical (affecting both left and right sides)
- get worse slowly, but surely
Other signs and symptoms
- swallowing difficulties
- muscle pain and tenderness
- reduction of weight
- Calcinosis (calcium deposits)
- Ulcers in the gastric area
- Perforations in the intestines
- Lung problems
Causes & Risk Factors
The exact origin of dermatomyositis remains unknown or idiopathic. Researchers believed that a viral infection that attacks the muscles might be the problem. Others believed that it may be a malfunctioning of the immunity system of our body.
All of us are at risk to have dermatomyositis, but usually children from five years old to 15 years old and adults from 40 years old to 60 years old are the target of this disease. Gender is also a risk factor because most often than not women will have this condition than men.
Polymyositis is a related disease, same symptoms, but the difference is it comes with no skin rash.
Dermatomyositis is generally without difficulty easy to diagnose because of its characteristic sign, which is skin rash compared to other muscle diseases. Sometimes, when a doctor seen a skin rash he might make a quick diagnosis of dermatomyositis, although there is no muscle weakness, the condition is known as amyopathic dermatomyositis.
Furthermore to make a complete diagnosis after physical assessment, your physician might use several confirmatory tests which commonly include:
Magnetic resonance imaging (MRI)
A scanner that produces cross-sectional images of your muscles from information made by strong magnetic field waves.
A physician with expertise put in a fine needle electrode inside the skin toward the affected muscle. Electrical movement is determined as you relax or stiffen the muscle, and alterations in the arrangement of electrical activity can verify a muscle ailment. The physician can verify the allocation of the disease by testing various muscles.
A smaller section of muscle tissue is detached by surgical means for laboratory testing. In dermatomyositis, inflamed cells encircle and injure the small blood vessels located in the muscle. A muscle biopsy may show swelling inside your muscles or other problems, such as injury or infection. The removed tissue can as well be tested for the presence of anomalous proteins and confirmed for lack of enzymes.
Blood analysis will confirm if you have increased muscle enzymes levels, like creatine kinase and aldolase. Elevated creatinine kinase and aldolase levels can imply muscular damage. A blood analysis can as well identify particular antibodies related with various manifestations of dermatomyositis, which can assist in identifying the finest medication and management.
A smaller section of skin is detached for laboratory testing. The sample can verify the diagnosis of dermatomyositis and exclude other autoimmune disorders, like lupus. If the skin biopsy proves the diagnosis, there is no need for muscle biopsy.
Dermatomyositis can be managed with the aid of the following:
-it facilitates suppression of the body’s immune system and regulates the production of antibody. This will lessen the pain in the muscle and reduces skin swelling.
-Side-effects may happen if the medication is taken for a long period of time. Commonly osteoporosis, weight gain and diabetes can occur.
- indicated to reduce the inflammation.
-hydroxychloroquine and chloroquine phosphate
-a very important part of the treatment
-indicated to increase muscle strength and flexibility
-indicated for the removal of painful calcium deposits
The prognosis will be based on the degree of severity of the disease, the presence of tumor, and/or the presence of involvement of heart and lungs. There may still be muscle weakness although the patient is recovered.