A 46-year-old office worker, Mr. A, habitually bought and drank juice every morning when going to work. He also frequently replaced meals with dairy products like milk. One day, he suddenly started experiencing weakness in the muscles around his neck and shoulders to the point where combing his hair became difficult, and red rashes appeared on his finger joints. Surprised, he visited a hospital and was diagnosed with dermatomyositis. Dermatomyositis is a difficult-to-cure autoimmune disease that often coexists with cancer, so it is important to undergo detailed diagnosis.

 

◇Weakness and skin rash should not be taken lightly

 

Dermatomyositis is an autoimmune disease characterized by inflammation of the skeletal muscles. It is a rare disease occurring in about 5 to 10 per 100,000 people, but it can appear suddenly without warning signs. The main symptoms of dermatomyositis are muscle weakness and skin rashes. Muscle weakness particularly occurs in the neck, shoulders, pelvis, and thighs, making daily activities such as climbing stairs, combing hair, washing the face, and standing up difficult.

The skin rash is characterized by a purple rash around the eyelids called 'heliotrope rash.' In addition, there are ▲'Gottron's papules,' which are rough red rashes on the elbows, knees, wrists, and finger joints ▲'Shawl sign,' a red rash on the neck, chest, back, and shoulders ▲'Mechanic's hands,' where the palms and sides of the fingers become rough and cracked ▲'Photosensitivity,' where the skin becomes sensitive to sunlight ▲and 'calcium deposits,' where calcium accumulates under the skin. Professor Jung Seong-su of the Rheumatology Department at Soonchunhyang University Hospital said, "Severe inflammation symptoms can appear in the lungs, cardiovascular system, and gastrointestinal tract," and "Autoimmune diseases such as lupus, scleroderma, and rheumatoid arthritis may accompany."

The exact cause of dermatomyositis has not yet been identified. It is generally believed that autoimmune diseases are related to genetic predisposition, immune system abnormalities, environmental factors, and cancer. Among environmental factors, an imbalance of gastrointestinal bacteria is known to cause immune system abnormalities, leading to chronic inflammation.

 

Professor Jeong stated, "Since 70-80% of our body's immune cells are distributed in the gastrointestinal tract, long-term repeated poor eating habits can disrupt the balance of gut bacteria, which may influence the development of dermatomyositis." He also mentioned, "In addition, fatigue can worsen the symptoms of dermatomyositis, and measures such as UV protection, minimizing sun exposure, moisturizing, and maintaining indoor humidity are also necessary to avoid skin irritation."

◇Complete recovery is difficult, but treatment options such as biological agents are increasing

 

The diagnosis of dermatomyositis is based on symptoms such as skin rashes and muscle weakness, and involves blood tests to check muscle enzyme levels and autoantibodies, electromyography, imaging tests such as MRI, and muscle and skin biopsies if necessary. Additional tests may be performed to exclude other causes such as other autoimmune diseases, infections, or cancer. Differentiating from conditions that affect muscles such as muscular dystrophy, systemic sclerosis, lupus, Lyme disease, and infectious myositis is particularly important.

 

Treatment focuses on reducing inflammation and managing symptoms according to the patient's condition. Corticosteroids can be used as medication to reduce inflammation. For patients resistant to steroids, immunosuppressants such as methotrexate, azathioprine, and mycophenolate mofetil are used. Recently, biological agents like rituximab are also used for patients who do not respond to conventional treatments.

Antimalarial drugs can be used to manage skin symptoms, and physical therapy is recommended to maintain and improve muscle strength.

Professor Jeong said, "Using immunosuppressants can make patients vulnerable to infections, so thorough infection prevention measures are necessary," and "Regular monitoring is essential to check for drug side effects and disease activity."

 

◇Not contagious... but high risk of coexistence with cancer

 

Some patients wonder if infections are common because dermatomyositis is characterized by skin rashes. Dermatomyositis is an autoimmune disease where the immune system attacks the body due to an abnormal immune response, so it is not contagious. However, patients with dermatomyositis have a relatively higher risk of developing cancer. Especially after the age of 50, certain cancers such as ovarian, lung, stomach, and pancreatic cancers may coexist, so if diagnosed with dermatomyositis, a period of cancer screening may be necessary.

 

Professor Jeong Seong-su said, "In many patients with dermatomyositis, skin rashes appear as one of the initial symptoms, but some patients are first diagnosed due to symptoms such as muscle weakness or fatigue," and added, "Early diagnosis and active treatment have a positive impact on prognosis, so if symptoms are suspected, you should immediately undergo detailed examinations at a hospital for an accurate diagnosis."

 

 

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I've never heard of dermatomyositis before.

I need to examine it carefully.

 

I'm glad there is no contagion, but

Related to immune-related sexual activity,

 

It seems that the self-diagnosis form is also a bit difficult.

 

I need to first check if there are any areas on the skin that are turning red.