How do you manage worsening cutaneous dermatomyositis when muscle disease appears controlled?

The fact that the patient still has an active pruritic rash while tapering steroids suggests that the current regimen isn't fully controlling the disease, and it can affect quality of life. I would consider adjusting immunosuppression, either adding another agent or switching therapies. The specific...

Since mycophenolate helped and we tapered prednisone to 5 mg, I would not change it, but add methotrexate to the regimen. Hydroxychloroquine is another option, but sometimes hydroxychloroquine can cause rashes as well, and it is usually higher in dermatology patients than in lupus patients. I defini...

Perhaps you should also rescreen for malignancy as well. We had a patient diagnosed with transcription intermediary factor 1-gamma (TIF1-gamma)-positive dermatomyositis (DM) months after her gynecologic malignancy was removed surgically. The myositis responded to treatment, but the skin disease ling...