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Dermatology
Dermatomyositis
Built from Dermatology, 5th Edition
What’s inside
10 sections · 106 slides
Overview
- What this deck covers
Introduction & classification
What dermatomyositis is, and how it is grouped and named
- What dermatomyositis is
- Cutaneous and systemic findings at a glance
- Two different diseases, two different attacks
- History and current classification
- The idiopathic inflammatory myopathy family
- Revised classification system for the idiopathic inflammatory dermatomyopathies
- Amyopathic and hypomyopathic dermatomyositis
Epidemiology
Who gets dermatomyositis, and how often
- How common is dermatomyositis
- Clinical subtypes of dermatomyositis – demographics and associated findings
Pathogenesis
What triggers the disease, and how the damage happens
- What triggers dermatomyositis
- How the immune system injures skin and muscle
- Drug, vaccine, and infectious triggers
- Pathogenesis of dermatomyositis
- Pathogenesis of dermatomyositis (continued)
- Pathogenesis of dermatomyositis (continued)
- Autoantibodies - a fingerprint for each subtype
- Serum autoantibodies in adult and juvenile dermatomyositis
- Clinical phenotype by autoantibody
- Clinical phenotype by autoantibody (continued)
Cutaneous disease
The rashes, nail changes, and calcium deposits that mark the skin
- The two hallmark (pathognomonic) skin signs
- Heliotrope sign and eyelid edema
- Photodistributed facial erythema
- Where the rash appears - extensor surfaces
- Gottron papules over the knuckles
- Papular lichenoid Gottron papules
- Subtle Gottron papules with renal cell carcinoma
- Gottron papules with a poikilodermatous dorsal-hand plaque
- Papules over the extensor tendons of the hand
- Gottron papules that mimic psoriasis
- Gottron papules extending onto the extensor tendons
- Gottron sign of the elbows and knee
- Gottron sign with poikiloderma over the knuckles
- Poikiloderma - a key diagnostic clue
- Photodistributed poikiloderma and the holster sign
- Localized poikilodermatous changes of the lateral arm
- Poikiloderma of the outer upper arm
- Holster sign of the lateral thigh
- Subtle holster sign
- Erythematous papules of the sun-exposed chest
- Facial and neck plaques in a patient with multiple myeloma
- Itching (pruritus) - an important clue
- Pruritic plaques of the upper back (shawl sign)
- Nail-fold changes - an easy bedside clue
- Ragged cuticles and nail-fold telangiectasias
- Ragged cuticles and nail-fold hemorrhage
- Nail-fold capillary changes on capillaroscopy
- Calcinosis cutis
- Calcinosis cutis of the buttocks and knee
- Calcinosis cutis of the shoulder
- Other cutaneous patterns
- Less common cutaneous presentations
- Flat-topped papules in a patient with interstitial lung disease
- Mucocutaneous manifestations of dermatomyositis
- Amyopathic disease still needs full work-up
Systemic disease
Muscle, lung, heart, and overlap disease beyond the skin
- Muscle disease
- Lung disease and anti-MDA5 dermatomyositis
- Cutaneous ulceration in anti-MDA5 dermatomyositis
- Ulceration within a Gottron papule (anti-MDA5 dermatomyositis)
- Cardiac disease and anti-synthetase syndrome
Malignancy
Why every adult with dermatomyositis needs a cancer work-up
- The cancer link in adult dermatomyositis
- Who needs the most careful cancer screening
Pathology
What skin and muscle biopsies show under the microscope
- What the skin biopsy shows
- Interface dermatitis and dermal changes on biopsy
- What the muscle biopsy shows
Diagnosis & evaluation
Confirming the diagnosis and mapping every affected organ
- Confirming the diagnosis
- Diagnostic approach to adult dermatomyositis
- Differential diagnosis of dermatomyositis
- Differential diagnosis of dermatomyositis (continued)
- Differential diagnosis of dermatomyositis (continued)
- Differential diagnosis of dermatomyositis (continued)
- Differential diagnosis of dermatomyositis (continued)
- Differential diagnosis of dermatomyositis (continued)
- Look-alike conditions - key distinguishing clues
- Testing for muscle disease
- MRI signs of muscle inflammation
- MRI of the pelvic muscles - normal versus dermatomyositis
- Ultrasound of the triceps muscle
- Evaluation of the patient with dermatomyositis
- Evaluation of the patient with dermatomyositis (continued)
- Evaluation of the patient with dermatomyositis (continued)
Treatment
Treating the muscle disease, the skin disease, and calcinosis
- Treating muscle disease
- Steroid-sparing drugs for muscle disease
- Escalating therapy for skin disease
- Therapeutic ladder for dermatomyositis
- Therapeutic ladder for dermatomyositis (continued)
- Treating skin disease - a harder problem
- Treating calcinosis cutis and long-term care
- Outlook (prognosis)
- Key takeaways
- References
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)