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Understanding dermatomyositis and its potential treatment options

Dermatomyositis is an uncommon inflammatory condition. Typical symptoms of dermatomyositis comprise a unique skin rash, weakness of muscles, and inflammatory myopathy, or swelled muscles. Dermatomyositis can influence both children and adults. So, there’s no treatment for this disease, but signs can be controlled.

Causes

The specific cause of dermatomyositis has not yet been known. Though, it has numerous similarities with an autoimmune disease. An autoimmune disease is one on which your body’s defense cells, termed antibodies, destroy your healthy cells. But, having a weak immune system might also add up to getting the disease. For instance, having a viral infection might weaken your immune system and result in the development of dermatomyositis.

Symptoms of dermatomyositis

In maximum cases, the first symptom is a distinguishing skin rash on the chest, face, eyelids, around nails, knees, knuckles, or elbows. The rash appears to be patchy and commonly has a bluish-purple color.

You might also undergo muscle weakness that becomes worse over time. This muscle weakness generally springs up in your neck, arms, and hips and can be experienced on each side of your body.

Other symptoms might include:

  • muscle tenderness
  • muscle pain
  • problems swallowing
  • solid calcium deposits beneath the skin, this symptom is mostly observed in children
  • lung problems
  • fatigue
  • fever
  • unexpected weight loss

A subtype of dermatomyositis also exists, which involves the rash without not muscle weakness. This is called amyopathic dermatomyositis.

Diagnosis of dermatomyositis

Your physician will question you about your signs and symptoms and medicinal history and conduct a physical examination. Dermatomyositis is an inflammatory muscle disease that is easy to diagnose due to the rash linked with it.

Your physician may additionally order:

  • an MRI to spot any abnormal muscles
  • electromyography (EMG) to read electrical impulses controlling your muscles
  • a blood examination to monitor the levels of your muscle enzymes and autoantibodies (antibodies that damage normal cells)
  • a muscle biopsy to rule out inflammation and different problems linked with the condition in a unit of muscle tissue
  • So, skin biopsy to see changes produced by the condition in a sample of skin

Likely complexities of dermatomyositis

The muscle weakness and problems of skin associated with dermatomyositis can result in a number of issues. Some prevalent complications are:

  • gastric ulcers
  • skin ulcers
  • trouble breathing
  • problems with swallowing
  • lung infections
  • malnutrition
  • weight loss

Dermatomyositis can additionally be linked to conditions such as:

  • Raynaud’s phenomenon
  • interstitial lung disease
  • Myocarditis
  • connective tissue diseases
  • heightened risk of acquiring cancers

Treatment for dermatomyositis

For many people, no cure for dermatomyositis exists. Treatment can recover the state of your skin and decrease muscle weakness. Possible treatments involve medication, physiotherapy, or surgery.

Corticosteroid medicines, like prednisone, are the favored approach of treatment in maximum cases. They can be taken by mouth or applied topically onto your skin. Hence,  corticosteroids reduce the over-activity of the immune system and decrease the amount of inflammation-causing antibodies.

For some individuals, particularly children, symptoms might resolve fully following a treatment course of corticosteroids. This is known as remission. Remission might be long-lasting, and even permanent sometimes.

Corticosteroids, mainly in elevated doses, should not be applied for long periods of time due to their harmful side effects. Your physician will possibly give you a high dose at the start and then slowly lower it. So, some people can ultimately quit using corticosteroids in case their symptoms disappear and do not come back after discontinuing the medication.

In case only corticosteroids do not make your symptoms better, But your physician might prescribe additional medicines to suppress your overactive immune system.

Corticosteroid-sparing medicines are used to decrease the adverse effects of corticosteroids. Medications like azathioprine and methotrexate might be given if your case is difficult or if you develop any complexities from corticosteroids.

Intravenous immunoglobulin (IVIG)

If you develop dermatomyositis, it means your body is generating antibodies that are targeting your own skin and muscles. But, intravenous immunoglobulin makes use of healthy antibodies to obstruct these antibodies. IVIG comprises a mix of antibodies obtained from thousands of physically healthy individuals who donated their blood. These healthy antibodies are administered to you intravenously.

Additional treatments

Your physician might recommend taking additional treatments, but, including:

  • physical therapy to repair and preserve your muscle health, along with limiting the loss of muscle tissue
  • an antimalarial medicine, hydroxychloroquine, for a rash that persists
  • surgery to eliminate calcium deposits
  • medicines that alleviate the pain
Treatment with Low-dose naltrexone

Patients having amyopathic dermatomyositis need to treat their debilitating indications and symptoms, however, current treatments have numerous adverse/side effects that make them improper or unacceptable to patients and doctors. Low-dose naltrexone has appeared as an alternative option of treatment for patients believing in its effectiveness and low toxicity as observed in the treatment of different autoimmune dermatologic diseases including the case with ADM. The proof for safety and efficiency, yet, is still insufficient and more evaluation via well-designed investigations is needed. Before giving low-dose naltrexone to a patient, a thorough discussion of benefits and risks between the provider and patient needs to be performed.

Observing efficacy in numerous disease states, whether related to skin or not, Hence, supplements surety to the belief that low-dose naltrexone is truly having an influence and that the modern reports are not just a coincidence. Also, low-dose naltrexone offers a potentially low-cost, fewer-side-effect treatment option to our patients that should be considered. Additional research is certainly required to explain why low-dose naltrexone might be useful; but, the rarity of several autoimmune, skin-related conditions creates a challenge for researchers.

Is Low Dose Naltrexone a potential treatment option for Adult-Onset Dermatitis Herpetiformis?

Low Dose Naltrexone (LDN) is being utilized as an immune system regulator, giving relief to sufferers of autoimmune diseases and CNS disorders. Though it is not approved by the FDA, particularly for these diseases, doctors are allowed to prescribe LDN as an ‘off-label’ treatment where they think is appropriate.

The different conditions in which LDN seems to produce a therapeutic effect are joined. By their capacity to benefit from enhanced levels of endorphins, which are the body’s naturally occurring opioids – especially OGF.

In almost 2% of patients, dermatitis herpetiformis appears to be refractory to a gluten-free diet. A patient with celiac disease having diet refractory dermatitis herpetiformis was given low dose naltrexone as a treatment. Randomized controlled trials proved that the short-acting opioid antagonist (naltrexone) is an efficient treatment option for Crohn’s disease and fibromyalgia. The subject’s skin lesions remained present for two years, and within three months of using naltrexone, they went into complete remission. Researchers theorized that antigens associated with gluten stimulate memory B-lymphocytes responsible for producing autoimmune antibodies, and this might keep dermatitis herpetiformis in existence. Endorphins generated by up-regulation with low-dose naltrexone might decrease this B-cell activity.

Treating pain can be a complex trial, but the patient can benefit from an option that involves. Consideration of both physiological and psychological features of a patient’s symptoms. Healthcare providers have various tools at their avail when confronting the challenge of pain management. Managing the symptoms of pain with LDN as a single option of therapy might not always work. But, if the patient’s health situation is very inflammatory (like rheumatoid arthritis) making use of LDN can be greatly helpful in itself.

Reference post article link:

https://www.emuarticles.com/understanding-dermatomyositis-and-its-potential-treatment-options/

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