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Therapeutic Approach

Dermatomyositis (DM) is a systemic autoimmune inflammatory condition primarily affecting skin, muscle, and lungs. Patients with skin disease without objective evidence of muscle weakness are classified as clinically amyopathic. DM is associated with higher cancer risk and, as such, thorough evaluation for malignancy is important, especially during the first 3 years from disease onset. In addition, baseline pulmonary function tests are recommended, and should be repeated should new respiratory symptoms develop. Treatment is tailored according to organs involved, severity of disease, and medical comorbidities. In most cases, topical therapy is insufficient for control of cutaneous disease, and antimalarials are often considered first-line options for systemic treatment. Other systemic therapies used to treat other organ involvement can also be helpful for skin disease. This treatment table primarily focuses on the current evidence for managing skin manifestations of DM. For patients with muscle or lung involvement, collaboration with a rheumatologist, neurologist, and/or pulmonologist is recommended. See Table 47-1.

Table 47-1Dermatomyositis Treatment Table

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