John J. Cush, MD


July 27, 2000


What is the best treatment for a 55-year-old woman with dermatomyositis with erythroderma, panniculitis, and extensive calcinosis?

Response from John J. Cush, MD

Your question simplifies what must be a complex and difficult-to-treat clinical scenario. The answer is that there is no recognized, well studied, or universally agreed upon therapy for such a patient and that the individual problems need to be dealt with separately.

The current state of care would suggest that the mainstay of therapy for patients with dermatomyositis is corticosteroids (at least initially) and concomitant methotrexate at doses up to 25 mg/week (along with daily folate 1 mg supplementation).[1,2] Such therapy may or may not have a beneficial effect on the erythroderma and/or panniculitis. It would not have any effect on the calcinosis.

Please realize that "erythroderma" and "panniculitis" are not usually seen in patients with dermatomyositis and underscore the need for clarification or consultation with an experienced dermatologist and rheumatologist. There is no effective treatment for calcinosis.


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