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Dermatomyositis

Topical Pharmacological Management for Skin

Julie Paik, MD, MHS 
Reviewed on February 14, 2025
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Topical Management

Suggested first-line treatments for cutaneous symptoms include photoprotection, topical emollients, moisturizers, and topical anti-inflammatory medications.

  • Photoprotection with sunscreen, protective clothing, and vitamin D supplementation is the first course of management for cutaneous symptoms of Dermatomyositis (DM). As ultraviolet light is a trigger for cutaneous DM, to mitigating the exacerbating effects of ultraviolet light is important.
  • Moisturizers and emollients may be useful to control pruritus and associated burning. Aggressive management may include a combination of proper skin care with emollients to minimize xerosis, oral antihistamines, and other anti-pruritic agents such as amitriptyline or gabapentin.
  • Topical anti-inflammatory medications such as corticosteroids and calcineurin inhibitors are used for controlling local inflammation and decreasing erythema and pruritus. Stronger topical corticosteroids are generally reserved for areas with thicker skin…

Topical Management

Suggested first-line treatments for cutaneous symptoms include photoprotection, topical emollients, moisturizers, and topical anti-inflammatory medications.

  • Photoprotection with sunscreen, protective clothing, and vitamin D supplementation is the first course of management for cutaneous symptoms of Dermatomyositis (DM). As ultraviolet light is a trigger for cutaneous DM, to mitigating the exacerbating effects of ultraviolet light is important.
  • Moisturizers and emollients may be useful to control pruritus and associated burning. Aggressive management may include a combination of proper skin care with emollients to minimize xerosis, oral antihistamines, and other anti-pruritic agents such as amitriptyline or gabapentin.
  • Topical anti-inflammatory medications such as corticosteroids and calcineurin inhibitors are used for controlling local inflammation and decreasing erythema and pruritus. Stronger topical corticosteroids are generally reserved for areas with thicker skin (e.g., scalp, hands, and extensor surfaces), while lower potency topical corticosteroids can be used on thinner areas more prone to atrophy (e.g. the face).
  • Topical calcineurin inhibitors include tacrolimus and pimecrolimus and can be used on areas with thinner skin without the risk of atrophy. Calcineurin inhibitors are associated with the local side effect of burning with initial application, which usually decrease with repeated use.

Although some patients can achieve remission of their cutaneous disease with topical therapies alone, these are usually used as an adjunct to systemic agents in most patients with DM. For example corticosteroids plus immunosuppressants/immunomodulators such as methotrexate, hydroxychloroquine, azathioprine, and mycophenolate mofetil are common treatments. The choice of systemic agent should individualized and is dependent on the presence of other manifestations of DM, such as myositis or lung involvement.

References

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