Dermatomyositis

Skin signs of systemic diseases

The skin should not be considered as an isolated organ but rather as a definite functioning system that communicates with the internal environment. Skin signs of systemic diseases occur frequently and sometimes feature the first symptoms of an internal disease; furthermore, these manifestations may be the sole expressions of otherwise asymptomatic systemic disorders. A number of dermatologic signs, symptoms, and disorders can be invaluable as markers of systemic disease. Although a plethora of specialized modern diagnostic tests are available, the skin still remains the only organ of the body that is immediately and completely accessible to direct clinical examination. This contribution reviews the skin signs of systemic diseases. The description of the clinical features of skin lesions observed in several internal diseases will be useful to general physicians, internists, and dermatologists in the diagnosis of a systemic disease.

Life-threatening dermatoses due to connective tissue disorders

Connective tissue disorders such as scleroderma, dermatomyositis and lupus erythematosus are autoimmune, multi-system disorders whose clinical manifestations can be restricted to the skin or may involve many organs. The degree and rate of organ system involvement defer, as does the prognosis and rapidity of disease progression. In this article, scleroderma, dermatomyositis and lupus erythematosus will be reviewed in respect to their life-threatening potential.

Pruritus in adult dermatomyositis

Dermatomyositis has a significant clinical component of pruritus that has not yet been studied. Pruritus can significantly affect the life of patients. The aim of the present work was to study the degree of pruritus experienced by patients. A four-question survey was sent to patients with documented dermatomyositis. The survey used a 100-mm Visual Analogue Scale (VAS) to describe current, worst and daily pruritus, and the effect this has on daily activities. Twenty-six subjects returned completed questionnaires: four had no pruritus; the majority had a significant amount with means above 50 on the VAS. A mean of 44.6 was found for the effect on daily life. Further studies should be performed to examine the prevalence and severity of pruritus in this population and it's effect on their quality of life. Clinicians must be aware of the significant pruritus and provide adequate therapy to improve quality of life.

Physical activity and disablement in the idiopathic inflammatory myopathies

PURPOSE OF REVIEW

The sequelae associated with idiopathic inflammatory myopathy (IIM) often result in disability and decreased quality of life. Our understanding of how exercise mitigates disability may be facilitated through the use of a conceptual model. This review describes the enablement-disablement model applied to myositis and explores the role of physical activity in the enablement process.

RECENT FINDINGS

National and international organizations have revised their disablement models by acknowledging disability as a relational concept, refining the relationship of disability to quality of life, and incorporating the role of intervention through the enablement process. Disability associated with IIM may be complicated by aging-related comorbidities and decreased physical activity. However, data indicate that both short-term and long-term aerobic training results in improved aerobic capacity and decreased disability in adults with IIM. Strengthening regimens have also resulted in decreased functional limitations and disability for adults with polymyositis and dermatomyositis. While comprehensive exercise programs have not been shown to exacerbate disease activity or damage in people with IIM, their effectiveness for individuals with inclusion body myositis (IBM) remains uncertain.

SUMMARY

Physical activity constitutes a valuable enablement strategy that can reduce disability in adults with IIM. Use of the disablement-enablement model and ICF taxonomy in conjunction with outcomes across disablement domains may augment further investigation of the effectiveness of exercise interventions. Additional research is needed to better understand the relationship between disease severity and optimal exercise dosage, the effects of long-term exercise in children with IIM, and the physiologic response to exercise in people with IBM.

Dermatomyositis: an overview of recent progress with emphasis on dermatologic aspects

Important points regarding DM and C-ADM are as follows: C-ADM is a working functional designation for patients having the skin-only and skin-predominant subsets of DM, amyopathic DM, and hypomyopathic DM. C-ADM seems to have approximately 10% the incidence of classic DM in whites and possibly a higher incidence in Asians. Some patients who present with C-ADM, with or without subclinical laboratory abnormalities, can slowly progress to develop symptomatic muscle weakness over a period of years, whereas others go for 10 to 20 years and longer without the appearance of muscle weakness. C-ADM patients are at risk for potentially life-threatening complications of classic DM, such as interstitial lung disease, which may occur in up to 10% of C-ADM patients. This risk seems to be even greater in some ethnic subgroups (e.g., Japanese). C-ADM patients may also be at increased risk for internal malignancy and until further studies are carried out to confirm the statistical significance of this association, all such patients should have a thorough evaluation for internal malignancy, identical to the approach currently used in classic DM patients. Dermatologists are in the best position initially to diagnose C-ADM patients and can contribute greatly to their overall management and quality of life. Ongoing vigilance is required, however, for complications that can arise in C-ADM patients including potentially fatal interstitial lung disease, internal malignancy, delayed onset of muscle weakness from myositis, and complications of systemic drug therapy. Topical therapy with broad-spectrum sunscreens, anti-inflammatories, and antipruritics should be maximized during the initial management of the cutaneous manifestations of either classic DM or C-ADM. Single-agent or combined aminoquinoline antimalarial therapy represents the safest initial form of systemic therapy for DM-specific skin disease occurring in any clinical setting; however, this approach tends to be less effective in general than for cutaneous LE. There is a theoretical rationale for and limited preliminary successful anecdotal experience with the use of anti-TNF-alpha therapy in refractory cases of classic DM and C-ADM. Cautious systematic clinical trials in this area should be considered.